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Full text of "Handbook of the Hospital Corps, United States Navy"

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HANDBOOK 

OF THE 

HOSPITAL CORPS 

UNITED STATES NAVY 

1953 



PI 111 1SIIKK HV 

THE BUREAU OF MEDICINE AND SURGERY 

DNDKB THE AITHORITV Of 

THE SECRETARY OP THE SAW 




NavMed P-5004 



I KI> SI A 
GOVERNMENT PRINTING 
WASHINGTON 



For sale by tho Superintendent «t Dnrunn • '-inlinr Office 

Washington J - .. I >. ('. - i Bocfcna 



FOREWORD 

The Hospital Corps, United States Navy, has gained foritselfa proud and 
unique position, in the 64 yeara Bince Cm.. tabliahed if as an organized 

unit (.1 the Medical Department The 25 charter members of the Corps, 
they mil, us today, would -lory in the accomplishments of their colleagues and 

successors, who now number more than 30, The memorable commendation 

by the late Secretarj of the Navy, the HoAorable James Porrestal, at the < 

oi World War II. ia but a single indication of a conti ua record unmatched 

for outstanding service by anj similar unit, pas! or present 

The technical competence and high morale of the Hospital Corpa ia based 
equally on the fine qualitj of personnel assigned to the ( !orpa and on the careful 
training afforded each member. Thia begina in the basic and advanced corpa 
schools, but is only fully effective if followed up by continuous study on the 
part oi the individual corpsman. To be prepared to render the beet possible 
aid to the sick and wounded, it ia essential to continually develop new knowl- 
edge and skills and to keep abreast of all recenl developments. 

This Handbook of the Hospital Corps, L953, is a lineal successor tot 
of such books which began in L014, but it ia not strictly » new edition of any 
of them, being largely rewritten and containing much new material I 
officially approved aa a textbook for the instruction of hospital corpamen, not 
only of the Navy but of other Government services which may choose to use 

it. It is intended also to Berve as a guide and reference book for all < orpa n, 

especially those on duty independent of a medical officer. The many naval 
officers and enlisted men who collaborated in producing thia handbook deserve 
unstinted praise and congratulations on the quality of their product 



La MONT Till. 

/.'■ ! 



ACKNOWLEDGMENTS 

The editorial board i«> compile and edit a new Handbook <if the Hospital 
Corps of the United States Navj consisted of the following: 

Capt. B. W. Hogan, MC, D. S. Navy, Commanding, U.S. Naval Hospital, 
National Naval Medical ( tenter, Bethesda, Md., chairman. 

Capt. C. G. McCormack, MC, U. S. Navy, Director, Professional I >i\ iaion, 
Bureau of Medicine and Surgery, member. 

Capt. B. F. Avery, MC, U. S. Navy, Director, Publications Division, 
Bureau of Medicine and Surgery, member. 

Capt. G. L. Parke, 1>C U. S. Navy, Head, Professional Branch, Dental 
Division, Bureau of Medicine and Surgery, member. 

(Mr. M. E. Zimmerman, MSC, l*. S. Navy, Commanding, U. s. Naval 
School of Hospital Administration, National Naval Medical Center, Bethesda, 
Md., member. 

Lt. Elizabeth Feeney, NC, U.S. Navy (representing Capt. Winnie Gibson, 
NC, U. S. Navy). Bureau of Medicine and Surgery, member. 

Mr. Gordon Barnes, Director, Administration Division, Bureau of 
Medicine and Surgery, member. 

LCdr. Clarence Shearer. MSC, U. S. Navy, U. S. M ival Medical School, 
National Naval Medical Center. Bethesda, Md., Executive Secretary. 

The editorial board herewith expresses deep appreciation and gratitude to: 
Hear Adm. ( 'larence .1. Brown. M( '. I . S. Navy, I )epnty Surgeon General, 

U. s. Naw. for his stimulating interest, valuable advice, and encouragement 

to the editorial hoard. 

Special gratitude is extended to Mary P. Billmeyer, Consultant and 
Assistant Professor in Orthopedic Nursing, School of Nursing Education, 

Catholic University <d' America, for advice and direction in the preparation 

of the text and illustrations for the "moving and lifting" and "position" por- 
tions of the chapter <>n Nursing and Nursing Procedures; and to other meml 
of the School of Nursing Education, Catholic University, who reviewed the 
manuscript and offered many valuable suggest ions. 

Melvin J. Iladden. I1M( '. I'. S. Navy. for many of the illustration- in the 

handbook. 

The Executive Officer, Hospital Corps School. Portsmouth, Va.. and to 

the members id' the school -tall and faculty for the preparation of the majority 
of the chapters in manuscript form, the typing, mimeographing of all chap' 
and for many of the illustrations. 

For review of the many chapters and for their very helpful and u-eful 
comments, suggestions, and recommendations: 

The Fleet Medical ( Hficer, U. S. Pacific Fleet, and the members of his staff. 

The Fleet Medical ( Mficer, U.S. Atlant ic Fleet, ami the members of his -tall. 

The Commanding Officers and the members of their stall . I S Naval 
Hospital Corps Schools. Great Lake-. 111.; Bainbridge, Md.: and San Di< 
Calif. 



vi HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 

The Commanding Officer, National Naval Medical Center, Bethesda, Md., 
. and members of his staff. 

The Commanding Officer, U. S. Naval Medical School, NNMC, Bethesda, 
Md., and the members of his staff for preparation of manuscripts and modifi- 
cations thereto ; the photographic department for many of the photographs used 
throughout the handbook; the lithographic department for the color plates; 
and the audiovisual department for many of the illustrations. 

The Commanding Officer, U. S. Naval Dental School, NNMC, Bethesda, 
Md., and the members of his staff for the section on Emergency Dental Treat- 
ment, and the illustrations therein. 

The Chiefs of Services, U. S. Naval Hospital, NNMC, Bethesda, Md., 
for their cooperation, review of revised manuscripts, comments, and recom- 
mendations. 

The Senior Medical Officer, Field Medical School, Camp LeJeune, N. O, 
and the members of his staff for the chapter on The Medical and Dental Depart- 
ments with the Fleet Marine Force. 

Director, Preventive Medicine Division, Bureau of Medicine and Surgery, 
and members of that Division for the chapter on Preventive Medicine. 

The Director, Navy Nurse Corps, Bureau of Medicine and Surgery, for 
the chapter on Nursing and Nursing Procedures, and the many members of the 
Nurse Corps who shared in the preparation of this and other chapters. 

The Armed Forces Institute of Pathology for the photographs in Nursing 
and Nursing Procedures and the many valuable suggestions on illustrations. 

The many Medical, Dental, Medical Service, Nurse and Hospital Corps 
officers throughout the Navy who have contributed proposed manuscripts and 
have offered many valuable suggestions. 

The clerical staff, both civilian and enlisted, of the Nurse Corps and 
Preventive Medicine Divisions of the Bureau of Medicine and Surgery; and 
the Naval Hospital, the Naval Medical School, and the Naval Dental School, 
NNMC, Bethesda, Md., for typing of manuscripts and modifications thereof. 



TABLE OF CONTENTS 

Pact 

FOREWORD .11 

ACKNOWLEDGMENTS ... v 

CHAPTER I. HISTORY OF THE HOSPITAL CORPS ... 1 

II. ANATOMY AND PHYSIOLOGY ... 7 

[ntroduction 7 

Skeletal System ... 1 1 

The Muscles 17 

Special Membranes and Glands l'ii 

Blood mikI Blood Vascular System 20 

Lymph and Lymph Vascular System 

Respiratory System 

Digestive System 31 

Endocrine System 

Excretory System 

Reproductive System 40 

Nervous System 43 

Special Senses 16 

III. FIRST AID AND EMERGENCY PROCE- 

DURES 49 

[ntroduction 

Hemorrhage 49 

Asphyxia ">l 

Shock 58 

Inflammation 61 

Wounds 

Injury of Muscles. Joints, and Bones 7-1 

Bandages and Bandaging v. 

Transportation of the Injured 94 

Miscellaneous Emergencies 

Emergency Medical Treatment 102 

Anesthesia . 124 

Emergency Dental Treatment 129 

IV. NURSING AND NURSING PROCEDURES 149 

Orientation to Nursing anil Nursing Pro- 

lun 9, Unit I . 149 

ic Nursing ( 'are. Unit 1 1 l ">l 
Vaaiating with an<l Performing Diagnostic and 

Therapeutic Procedures, I'nit III 196 
Adaptations of Nui I ire, Unit IV 

Ward Management, Unit V 285 
Introduction to the Operating Room and 

Centra] Supply, Unit VI 
Appendix .311 

vii 



viii HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 

Page 

V. FOOD IN HEALTH AND DISEASE 319 

Diet in Health 319 

Diet in Disease 322 

Classification of Diets 324 

VI. PREVENTIVE MEDICINE 327 

Communicable Diseases 327 

The Body's Defense Against Disease 329 

Special Disease Problems 331 

Personal Hygiene 336 

Group Protection Against Disease 339 

Sanitary Mess Facilities 340 

Essentials of Healthful Living Conditions 

Ashore and Afloat 345 

Control of Insects and Carriers 347 

Hygiene and Sanitation Under Field Condi- 
tions 356 

Industrial Health Problems 361 

VII. MATERIA MEDICA AND PHARMACOL- 

OGY 369 

Introduction to Materia Medica 369 

Acids and Antacids 370 

Digestants 373 

Cathartics 374 

Stomachics, Bitters, Aromatics, and Carmina- 
tives 377 

Emetics and Expectorants 379 

Demulcents and Emollients 381 

Protectives, Inert Substances, and Adsorbents. 383 

Irritants, Astringents, and Lead Salts 384 

Diuretics and Choleretics 389 

Cardiac Drugs 390 

Nervous System Stimulants and Depressants,. 394 

Opium and Its Alkaloids 399 

Autonomic, Parasympathomimetic and Sym- 
pathomimetic Drugs 401 

Autonomic Blocking Agents 404 

Oxytocics 406 

Analgesics and Antipyretics 407 

Anesthetics, General, Basal and Local 409 

Antiseptics, Germicides, Fungicides, Parasiti- 
cides, and Disinfectants 412 

Medicinal Dyes 421 

Sulfonamides 422 

Antibiotics 425 

Anthelmintics 427 

Arsenicals 429 

Antimalarials 431 



TABLE OF CONTENTS j x 



VII. MATERIA MEDICA AND PHARMACOL- 

OGY — Continued 

Amebacides 

Biologicals 434 

Iodides mid Calcium Salts 437 

Drugs used in Treatmenl of Anemias 

Endocrine Products 

Vitamins 1 1 ; 

Coagulants and Anticoagulants 446 

Diagnostic Agents -1 17 

Flavoring Agents - 443 

Coloring Agents and Solvents 449 

VIII. PHARMACY ... 461 

Weight and Volume 452 

Weights and Measures 452 

Pharmaceutical Arithmetic 

Beat . ( iomminution, and Solution 
Separation of Solids from Liquids 

Extraction 467 

Pharmaceutical Preparations 

Prescriptions.. 171 

Narcotic Control in the Navy __ 476 

Incompatibility -. 

Latin Terms Used in Prescriptions . 487 

IX. CHEMISTRY 489 

Inorganic Chemistry 

Organic < Jhemistry 

X. LABORATORY TECHNIQUES AND PROCE- 
DURES 617 

Bacteriology 517 

Miscellaneous Bacteriologic Tests 525 

I 'rinn lysis 

Somatology 527 

Methods of Obtaining Blood :.:;i 

Blood Grouping and Matching 

Animal Parasitology 

Examination For Malarial Parasites 54] 

Arthropods 543 

Serology 546 

XL EMBALMING 

Introduction 

Preparation of the Body for Embalmii 554 

Arterial Injection. Cavity Injection 
( Savity Injection 

Embalming s Posted Body ">''>i 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Page 

XI. EMBALMING— Continued 

Preparation and Encasement of Body Outside 

the Continental Limits of the United States _ 562 

Special Cases 562 

XII. THE MEDICAL AND DENTAL DEPART- 

MENTS WITH THE FLEET MARINE FORCE. 567 

Organization of the Medical and Dental Depart- 
ments with the Fleet Marine Force 567 

Medical Aid Practice in the Field 571 

Morphine and Other Narcotics 572 

Field Sanitation 574 

XIII. MEDICAL ASPECTS OF ATOMIC WAR- 

FARE 581 

The Atom, Atomic Energy, and Fission 581 

Effects of Atomic Explosions and Radiological 

Hazards 584 

Medical Aspects of an Atomic Explosion 591 

The Burn Problem in Atomic Warfare 600 

First Aid Treatment of Casualties from Atomic 

Bombing 601 

Decontamination, Personnel and Materiel 604 

XIV. CHEMICAL WARFARE 607 

The Common Chemicals of Warfare 607 

The Lung Irritants 608 

The Vesicants ., 609 

The Tear Gases. . . . 611 

The Vomiting Gases 611 

The Blood and Nerve Gases 612 

The Screening Smokes 613 

Other Noxious Gases 614 

The First Aid Treatment of Gas Casualties 616 

XV. BIOLOGICAL WARFARE 621 

General 621 

Biological Agents 621 

Medical Aspects of Biological Warfare 622 

Employment 623 

Detection of Biological Attack 623 

Individual Protection 624 

Collective Protection 625 

Tactical Protection 626 

XVI. MEDICAL DEPARTMENT ADMINISTRA- 

TION 627 

Principles of Administration 627 

Organization of the Department of the Navy.. 627 



TABLE OF CONTENTS 



Pica 

XVI. MEDICAL DEPARTMENT ADMINISTRA- 

TION— Continued 

The Bureau <>f Medicine and Surgery 627 

The Hospital Corps 

Pood Service Division, \:i\;il Hospitals 

Special Sen ices 

( lorrespondence 

Personnel Records Managemenl 640 

Deaths and Medicolegal Matters 641 

Training Facilities in the Navj 644 

Finance 6 1 5 

XVII. INDEPENDENT DUTY 651 
GLOSSARY 

INDEX 



Chapter I 

HISTORY OF THE HOSPITAL CORPS, UNITED STATES NAVY 



A Commendation by the Secretary 
of the Navy 

Out of Every LOO Men of the United States Navj 
and Marine Corps who were wounded in World 
War II. ( .»7 recovereda 

That is a record doI equaled anywhere, any 
time. 

Every individual who was thus saved from 
death, owes an everlasl ing debl to the Navy's Hos- 
pital Corps. The Navy i- indebted to the Corps, 
Tlie entire nation is its debtor, for thousands of 
citizens are living normal, constructive, happy 

and productive lives who. hut for the skill and toil 

of the I [ospital Corps, might he dead or disheart 
ened by crippling invalidism. 

So, to the 200,000 men and women of the Hos 
pita! Corps, I say in behalf of the Tinted State- 
Navy: '"Well Done. Well done, indeed!'* 

Without your service, the Navy*- .Medical Corp- 

couldnot have achieved the Life-saving record and 
the mind-saving record its physicians and surgeons 

and psychiatrists achieved. That others might 

live, your fellow corpsinen have given their Lives; 

889 of them were killed or mortally wounded. 
Others died as heroically from diseases they were 
trying to combat. In all, the Corp-' casualty li-t 
contain- 1,724 names, an honor roll of special dis- 
tinction because none among them bore arm-. 

The Hospital Corpsmen saved lives on all the 
beaches that the Marines stormed. ( 'orpsinen were 
at the forefront of every invasion, in all the ac- 
tions at sea, on all carrier decks. You were on 
your own in submarines and the smaller ship- of 
the fleet, performing emergency surgery at time- 
when you had to take the fearsome responsibility 
of trying to save a life by heroic means or 
the patient die. Your presence at every post of 
danger gave immeasurable confidence to your com- 
rades underarms. Their bravery was fortified bj 
the knowledge that the Corpsmen, the sailor- of 
solace, were literally at their -ides with the skill 



and mean- to -t:mch wound-, a I lav pain and to 

carrj them hack, if need I"-. to safe shekel and 

the ministrations of the fines' medical talent ill 

t he world. 

You Corpsmen perfon I fox-hole surgerj 

while -hell fragments clipped your clothing, aha! 
tend the plasma bottles from which you poured 

new life into the wounded, and sniper's bullets 

were aimed at the hras-ard- OH your arm-. On 
[WO .lima, for example, the percentage of . a-ual 

tie- among your Corps was greater than the pro 
poii ion of losses among the Marine-. Two of your 
colleagues who gave their live- in that historic 
battle were posthumously cited for the Medal of 
Honor. One of the citations read- : "I ly hi- great 
personal valor in saving other- at the sacrifice of 
his own life (he) inspired hi- companion-. al- 
though terrifically outnumbered, to launch a 
fiercely determined attack ami repulse the enemj 

force." All that he had in his hand- were the tools 

of mercy, vet he won a memorahle viclorv at the 
cost of his life. 

No wonder men and women are proud to wear 

the emblem of the Hospital Corps! It is a badge 

of mercy and valor, a token of unselfish -ei | 

in the highest calling the Baving of life in the 

service of v our country. 

Your Corp-* men and women toiled, often a- 
daiiL r er<'ii-ly. never less vitally, in area- remote 
from battle: In hospital-, on hospital -hip-, in 
airplanes, in laboratories and pharmacies and dis 
pensaries. 'liny helped, and are helping i for the 
task is far from over) in the salvage of men's 
broken bodies and minds that is the L r rim product 
and perennial aftermath of war. Some of yon 
contributed tow ard new techniques in research and 
practice. Some used particular skill- in dental 

technology . some engaged in pest control to dimin- 
ish unfamiliar diseases, other- taught native- of 
di-t ant islands the benefits of modem h . ren 

to midwifery and everyday sanitation. 

< orpsmen, made prisoners of war, 

1 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



their skill and strength to retain life and hope in 
their fellow captives through long years of im- 
prisonment and deprivation. 

Whatever their duty, wherever they were, the 
men and women of the Hospital Corps served the 
Navy and served humanity, with exemplary 
courage, sagacity and effort. The performance of 
their duty has been "in keeping with the highest 
traditions of the United States Naval Service." 
That, to a Navy man or woman, is the highest of 
praise. The Corps has earned it, and continues to 
earn it. 

For, as I said, the task is not yet completed. 
Thousands of the war's casualties will long need 
the ministrations of physicians, nurses and the 
Hospital Corps before they can return to normal, 
peacetime pursuits. Hundreds may have to be 
cared for as long as they live; that these unfor- 
tunates are so few is in large measure due to the 
prompt, skillful aid accorded our wounded and 
stricken, by your Corps. 

Illness and accident will add to these numbers, 
of course. There will always be the sick and the 
injured, and there will always be need for trained 
personnel to help restore them. The Navy's busy 
laboratories are forever engaging in research to 
combat disease, to speed the healing of torn flesh 
and broken bones, to devise new aids for the 
maimed to lead a normal life. And so I am im- 
pelled to address this message not only to the men 
and women of the Corps who have completed their 
service to the Navy, but to those who are presently 
in the Corps, and, also, to those who are joining — 
or re-joining — in that inspiring career. 

It is no easy profession, even in peace time. 
There is danger in the test tubes and culture racks 
as menacing as in the guns of an unvanquished 
enemy. The Hospital Corps is never at peace. It 
is forever on the firing line in the ceaseless war 
against disease and premature death. That is why 
the Corps' emblem is truly "the red badge of 
courage," a designation to all the world that the 
person who wears it has been self-dedicated to the 
service of humanity. 

Customarily the "Well done" signal is reserved 
for the closing phrase of a message of congratula- 
tion, but I placed it in the forefront where, in this 
instance, it most fittingly belongs. I repeat it, 
here, with the postscript that in earning its "well- 
done," the Hospital Corps is assured no other unit 



in the Navy did better in the degree of essential 
duty inspiringly performed. 

(S) James Forrestal. 

The above commendation was written by the 
Honorable James Forrestal, Secretary of the 
Navy, later the first Secretary of National De- 
fense, at the close of World War II. Insofar as 
can be determined, this is the first time in military 
history that a single staff corps serving in so many 
diversified capacities, and scattered over so vast 
an area, has been commended by the Head of the 
Department. 

During World War II, a total of 15 enlisted men 
of the Navy were awarded the Medal of Honor. 
Of this number, 7, or 46 percent of the total receiv- 
ing this award were Hospital Corpsmen. The 
award of other personal medals, the Navy Cross, 
the Silver Star, the Bronze Star, etc., to the hos- 
pital corpsmen, has been by the tens and hundreds, 
almost too numerous to count. Wherever you 
find the hospital corpsman, the expression, espe- 
cially in time of war, "Above and beyond the call 
of duty" is commonly heard. 

What is the basis for the above? Why have so 
many members of the Corps been cited for per- 
formance of duty and for gallantly giving their 
lives in an attempt to save life? For a complete 
understanding of the esprit de corps of the Hos- 
pital Corps, it is necessary to regress and review 
the past upon which this corps has been built and 
the traditions which it has established. 

From the very beginning of the Navy it was 
found necessary to make provisions for the care of 
the sick and injured. An act of Congress 1799, 
provided : "A convenient place shall be set apart 
for the sick and hurt men, to which they are to be 
removed, and some of the crew shall be appointed 
to attend them." That portion of the ship assigned 
for the care of the sick was designated as the cock- 
pit. It was usually located in the forward part of 
the vessel, below the water line as a protection 
from shot and shell. The cockpit was also re- 
ferred to as the "sick berth" and in later years it 
became known as the "sickbay," as the rounded 
shape of the recess or bay was located in the for- 
ward part of the ship between decks. 

During the Revolutionary War period there 
were apparently no enlisted men trained in the 
care of the sick and injured. A number of the 



HISTORY OF THE HOSPITAL CORPS 



least iir.r-~.iiT members of the crew were assigned 
this duty. Most of the ships of tins period, de 
pending on size, carried ;i Burgeon and a Burgeon's 
mate. 

In L814, Navy Regulations referred to the 
"loblolly boy" who was to serve the Burgeon and 
Burgeon's mate. It was, among many others, the 
duty of the loblolly 1 >< > \ to go fore and afl the 
gun and berth decks ringing a small bell to give 
notice to "those slightly indisposed and with 
ulcers" to attend the surgeon at the mainmast. 
Both from old Navy Regulations and from authen- 
tic accounts of shipboard lite of that day, the 
loblolly hoy was before battle, to provide the 
cockpit with water, containers for amputated 
limbs, braziers of charcoal for heating the iron- 
to sear the stumps caused by amputations, and 

for heating tar with which to stop hemorrhage. 

He was also to provide buckets of -and to catch 
the blood from amputation- and wound-, ami to 
pour over the blood on the deck- 80 that the >ur- 
geon might not -lip while working. Gruesome 
and crude? Yes. But the method- in u-e today 
may sound the same way to persons nearly 300 
year- from now. It niii.-t lie remembered thai 
the customary treatment for compound fractures 
of limbs at that time wa- usually amputation. 
During boarding of vessels, hand to-hand combal 
with cutlasses, gun butts, clubs, and the use of 
cannon with round halls that did not explode, hut 

were heated red hot before being fired, evidently 

resulted in many fracture- which were eventually 
amputated. 

The Bureau of Medicine and Surgery was estab- 
lished in L842. An extract from a letter in this 
bureau dated 5 May 1843, read- as follow.-: 

A circular is new under consideration to allow a -nr- 
geon's steward to all hospitals and vessels, without n. 

>ity to sign articles, hut to he appointed. 
So far as can lie determined, the surgeon's 

steward superseded the loblolly bo\. The pay of 

the surgeon's steward is first listed as being $18 
pel- month and one ration. 

A sargeon'8 steward i- allowed at all hospitals and 
navy yards and on hoard cver\ vessel baring a medical 

officer. As it is important that a respectable class of 
persons should he employed in this capacity, surgeons 
will endeavor to select such as have some knowledge of 
pharmacy and ordinary account- and are of industrious 
and temperate habits (instructions for Medical Officers, 
r. s. Navy, is:,?,. 



This was ei idently the begini 
of specially qualified personnel, 

In 1863 an order of tin- N:i\\ Department al- 
lowed male nurses on receiving ships in nam 

proportionate to I he tic. i of I he I 

Burgeon's stewards to rank next after master-at-arma 
(who was i he leading petty officer c.r the vessel), and 
surgeon's stewards are never to be discharged without 
the consent "f the officer appointing them ..r then 
-..I-, except bj sentence ••( a court martial >i s \ 
Regulations, 18< 

An order of the \av\ Department dated - I >• 

cember 1866, reads in pari : 

The designation of persons sen inw- 
ards i- changed to thai « -r Apothecary, and they wii. 
appointed for duty in the Medical Department "f Use 
Navy, ashore and afloat, in the same manner n's 

stewards have heretofore been appoii 

indldate for examination ami iir-t enlii 
apothecary must I late ••( some 

of pharmacj and must be between 21 and 28 
c I" s Navj Regulations, IS 

About the year 1873 the title of male n 
changed to thai of Dayman. 

The Burgeon's division shall consist ><t all junior 
cal officers of the -hip. the apotbecarj . and the baj i 

Baymen shall he given a course ■•! Instruction on i 
the receiving ship or at a naval hospital before bt 
drafteii for service on ■ seagoing -hip. 

Baj men i formerly called ■■ • rsonal at 

ants on the sick (U. 8. Na 

From the above it can In- Been that education 

and courses of instruction were ne< .— ar\ and t 
i- believed to be the forerunner of the pie 

Hospital Corps schools. It also indicates that the 
shore-sea billet rotation v ilished even at 

that early dale. 

Hospital Corps, Its Origin, 1898 

The Hospital (otp- came into cxi-tence a- all 

organised unit of the Medical Department under 

the provisions of an act of Congress, approved 17 
dune 18 

This act provided for appointment to the war- 
rant rank of pharmacist, and established the fol- 
lowing rati- [ 

in) Hospital Steward (chief petty officer). 

ib) Hospital Apprentice Firs! Class (third 
class I'ctt \ officer). 

Hospital Apprent 

In accordance with this act. the Secretary of 
the Navy appointed •_'.'• senior apothecaries of the 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Navy as pharmacists. These original 25 are 
rightfully referred to as the charter members of 
the Hospital Corps. The dean of these was 
Cornelius O'Leary, who was credited at date of 
appointment with 37^ years of service as an 
apothecary. 

In 1900, during the Boxer uprisings in China, 
the first member of the Hospital Corps was 
awarded the Medal of Honor. The citation reads 
in part : "Standley, Robert, Hospital Apprentice, 
U. S. N. in action with the relief expedition of 
the Allied Forces in China during the battles of 
13, 20, 21, and 22 June 1900. Throughout this 
period and in the presence of the enemy, Stand- 
ley distinguished himself by meritorious conduct." 
Standley retired from the Navy on 1 February 
1939 with the rank of Chief Pharmacist and died 
on 15 July 1942. 

An act of Congress, approved 22 August 1912, 
provided that pharmacists after 6 years from date 
of warrant and after satisfactorily passing pre- 
scribed examinations should be commissioned 
chief pharmacists. 

The Hospital Corps was reorganized by an act 
of Congress approved 29 August 1916. This act 
is considered of sufficient importance to quote in 
part: 

Hereafter the authorized strength of the Hospital Corps 
of the Navy shall equal three and one-half percentum of 
the authorized enlisted strength of the Navy and Marine 
Corps, and shall be in addition, thereto, and as soon as 
the necessary transfers or appointments may be effected, 
the Hospital Corps of the United States Navy shall con- 
sist of the following ratings: Chief Pharmacists. Pharma- 
cists, and enlisted men classified as Chief Pharmacist's 
Mates ; Pharmacist's Mates, First Class ; Pharmacist's 
Mates, Second Class; Pharmacist's Mates, Third Class; 
Hospital Apprentice, First Class ; Hospital Apprentice, 
Second Class ; such classifications in enlisted ratings to 
correspond respectively to the enlisted ratings, Seaman 
branch. * * * Provided, That enlisted men in other 
ratings in the Navy and in the Marine Corps shall be 
eligible for transfer to the Hospital Corps and men of 
that Corps to other ratings in the Navy and Marine 
Corps. * * * The Secretary of the Navy is hereby 
empowered to limit and fix the numbers in the various 
ratings. * * * and emoluments of enlisted men of the 
Hospital Corps shall be the same as are now, or may, 
hereafter, be allowed for respective corresponding rat- 
ings. * * * Hospital and ambulance service, with 
such commands and at such places as may be prescribed 
by the Secretary of the Navy, shall be performed by 
members of said Corps, and the Corps shall be a constituent 
parr of the Medical Department of the Navy: * * * 



During World "War I, 10 of the 13 chief phar- 
macists were promoted to lieutenant (MC), 
U. S. N. During the war there were 94 tempo- 
rary commissioned and warrant officers, and 
16,000 enlisted men in the Hospital Corps. 

During World War I, the reputation of the 
Hospital Corps for performance of duty, espe- 
cially in the field with the Marine Corps, was 
greatly enhanced. Many of the members were 
cited for valor and performance of duty under 
fire, by both the United States and France. 

In July 1922, all members of the corps holding 
temporary commissions or warrants were reverted 
to their respective permanent ranks or ratings. 

From the period of World War I to World 
War II, the Hospital Corps became one of the 
outstanding corps of the military services. More 
schools were provided, qualifications for advance- 
ment in ratings were raised, and a high degree 
of technical skill and knowledge was demonstrated 
by all members of the corps. 

Secretary of the Navy, the late Honorable James 
Forrestal, eloquently described the performance 
of duty of the Hospital Corps during World 
War II. No further eulogy, prose, or praise can 
better describe the corps and their actions during 
that period. 

During World War II, women were first brought 
into the Hospital Corps. On 12 January 1944, the 
first Hospital Corps School for WAVES was 
commissioned at the U. S. Naval Hospital, Na- 
tional Naval Medical Center, Bethesda, Md. The 
first class consisted of 230 enlisted women. 

Public Law 625 of the Eightieth Congress, ap- 
proved 12 June 1948, made the WAVES an in- 
tegral part of the Regular Navy. 

Public Law 337, Eightieth Congress, approved 
4 August 1947, established the Medical Service 
Corps. The law provides that the authorized 
strength of the Medical Service Corps shall be 
equal to 20 percent of the authorized strength of 
the Medical Corps of the Navy. It provides for 
commissioned grades of ensign to captain, in- 
clusive. It consists of four sections : Allied science 
section, consisting of those holding degrees in 
sciences allied to medicine ; pharmacy section, con- 
sisting of those holding degrees from schools of 
pharmacy ; optometry section, consisting of those 
holding degrees from schools of optometry ; and 
the supply and administrative section, consisting 



HISTORY OF THE HOSPITAL CORPS 



generally of former pharmacists and chief phar- 
macists, chief and firsl class pettj officers of the 
Hospital Corps. It is now possible for the 
hospital apprentice with diligence, study, effort, 
and conscientious application to dutj to attain 
the rank of capi a in. Medical Service Corps. 

On 2 April 1948, the nomenclature of the II" 
pital Corps ratings were changed t<> read: 11"- 
pital recruit; h<»|>ital apprentice; hospitalman; 
hospital corpsman third class; hospital corpsman 
second class; hospital corpsman first class; chief 
hospital corpsman; warrant officer and commis- 
sioned warrant officer, Hospital Corps. 

At this tiint' those hospital corpsmen who were 

Classified as dental technicians, were changed to 
that rating. The rat ingsl met nre out line- the den- 
tal ratings as follow.-: Dental recruit: dental ap- 
prentice; dentalman; dental technician, third 
class; i lent a I technician, second class ; dental tech 
nician, firsl class; child' denial technician. 

Warrant and commissioned w arrant officer, Hos- 
pital Corp-, and Medical Service Corps officers t so 
qualified and assigned) perform administrative 

and technical duties in dental activities. 

The rating Insignia of the Hospital Corp- was 
changed from the Red Cross, so long familiar, to 

the caduceUS at this 1 Une. Dental technician- have 

the "I)" superimposed over the caduceus. 

The mission of the Hospital Corp- i> to give on 
land, sea, and in the air, intelligent, Capable, and 



efficient assistance to Medical. Denial. Medical 
Service, Nurse, and 1 1 -.-pit a I Corps officei in the 
eternal war against disease, injury, and death, and 
to aid iii maintaining the -upplv and administra 
ii\e function- of the supportive branches of the 
Medical Departmenl : in the absence of these offi 
io display the knowledge and judgment re 
quired to meet all emergencies ami m everj pot 
aible manlier assisl io the best of then- ability, 
training ami knowledge in the function of the 

I lical department of the \.i\\. i. e.. tu /•/<// M 

many int H at us many '/'/><•- </v many dayt at 
possibli . 

This complex mission requires from each mem 
berofthe Hospital Corps a versatility neither de 
manded nor expected of other enlisted ratings in 
the navy. 

Wherever you find the Navy, wherever yon find 

the Marine Corp-, there you will find the 

Hospital Corpsman. In times of peace, he toils un- 
ceasingly, day and night, often m routine monot- 
onous duties. In time- of war, he is on the beached 

with the Marine-, is employed in amphibious oper- 
ations, in transportation of wounded by air. in the 
front battle line-, on all type- <.f -hip-, submarines, 

aircraft carrier-, landing craft. In -hort. 
w herever medical sen ice maj he required, the hos- 
pital corpsman i- there, not only willing hut pre- 
pared to -cive hi- country and hi- fellow man 

above ami beyond the call of duty. 



211806°— 53- 



Chapter II 

ANATOMY AND PHYSIOLOGY 



INTRODUCTION 

Study of the Human Body 

As ;i hospital corpsman, von must have a good 
basic knowledge <>t' how the human body is con- 
structed and how it work-. This is known as 
anatomy (structure) and physiology (function). 
In your job of caring for the sick and injured, 
you will be constantly interested in the body, dust 
as a successful automobile mechanic know- the 
parts of his machine, the hospital corpsman must 
be familiar with the part- of the body and how 
each operates. Although such a knowledge will 
not cure patients, it is a basic tool needed for the 
successful treatment of disease and injury. 

The human body is a combination of organ 
systems, with a supporting framework of muscles 
and bones and an external covering of .-kin. The 
smallest unit of life, the cell, is the building block 
of which all these organs and systems are made. 

The study of the body is divided into the follow- 
ing branches : 

1. Human anatomy is the study of body struc- 
ture and the relation of one part to another. De- 
scriptive anatomy is a word picture of the charac- 
ter, form, and size of various parts of the body. 
Surgical anatomy deals with special feature- of 
those portions of the body that arc important in 
the diagnosis and treatment of surgical diseases. 
Topographical anatomy is the study of the rela- 
tionship of parts of the body to surrounding part-. 
Surface anatomy concerns the form and markings 
of the surface of the body. It helps in locating 
on a patient such part- a- nerves or bones, which 
are hidden by the skin. 

2. Physiology is the study of how the body 
works. 

3. Embryology is the study of how the body 
developed from an ovum to its adult form. 



1. Histology i- the study of the minute form 
ami appearance of normal cells and i 

-tin with the aid of len-e- or a micrOSCO] 

... Pathology i- the study of the changes in 
organs and tissues caused bj disease. 
6. Biology is the study of all forma of life. 

B ■- meaning life: logy, tin- stud] of.) 

Classification of Living Matter 

Everything in nature is either animal, v< 
table, or mineral. Mineral- are without life and 
are known a- inorganic matter. Animal- and 
vegetables, which possess life, are known a- or- 
ganic. This mean- thai the\ .ne made up of 

materials that have been organised by life 
process* 

Any living thing, whether animal or vegetable, 
is an organism. The difference between them is 

that animal- have -eii-ation and power of volun- 
tary movement, and require oxygen and organic 
food. Vegetables (plants) require only carbon 
dioxide and inorganic mailer for fond, and do not 

have voluntary movement or special 
organs. 

Actually, plant- and animal- live for each other. 
Animal- need oxygen which phi off, and 

they require plant- for food, in order to obtain 
proteins, carbohydrates, and fat- for building 

body cell.-. They exhale carbon dioxide and 

off wastes, which are u-e.l by plants, 

The way in which plant- manufacture proteins, 

carbohydrates, and fat- i- interesting. When the 

ra\ - of i he -un -t like the green chlorophyll in the 

leaves of the plant, carbon dioxide from tl • 
and solutions of mineral -alt- from the soil are 
combined to form these organic material-, freeing 
o\\ Lien to give back to the air. 

Animal- eat food containu . ic materials 

and after digesting an I absorbing them either 



8 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



convert them into body cells or burn them, with 
the aid of oxygen inhaled into the lungs, to pro- 
duce energy. In the process, waste products are 
formed; some are excreted by the bowels and 
kidneys while others, mainly carbon dioxide, are 
exhaled from the lungs. 

Animals are classified in various major di- 
visions. Those with a backbone or a notocord, 
including fishes, reptiles, birds, and mammalia, are 
called vertebrates. Man belongs to the order of 
mammalia (those that nourish their young with 
milk), and is unique in having the power of ar- 
ticulate speech and ability to reason abstractly. 
Man is also known as a human being and it is his 
life processes that we will be studying in this 
chapter. 

Characteristics of Living Matter 

All animal and plant life has certain chemical 
processes by which life is sustained and cells re- 
generated. These processes, from the time food 
enters the mouth until it is made into tissues to 
repair the body or is burned to provide energy, 
are called metabolism. Metabolism involves the 
absorption, storage, and use of food for the growth 
and repair of body tissues. It also involves the 
combination of foods with oxygen to make energy, 
and the final elimination of waste materials. It 
is the burning of foods that supplies the energy 
for carrying on all the body processes and that 
maintains body temperature in warm-blooded 
animals. 

Another characteristic of living matter is that 
it is irritable and excitable. It responds to stimu- 
lation. Even a one-celled animal will move away 
when stuck with a pin, and you are all familiar 
with how you respond when this happens. Your 
nerves carry the impulse to your brain and your 
brain sends a message to your muscle to contract; 
thus you have an example of irritability and ex- 
citability. 

Living matter is also able to move and to re- 
produce. Nonliving matter cannot. When all 
vital functions stop and metabolism ceases, the 
organism is dead. 



The Cell 

All living cells are composed of a viscid, jelly- 
like substance called protoplasm. Upon it de- 
pend all the vital functions of nutrition, secretion, 
growth, reproduction, irritability, and movement. 
Actually, protoplasm has in it the secret of life 
itself. 

A typical cell is made up of a cell wall, cyto- 
plasm, nucleus, and nucleolus. The simplest liv- 
ing organisms consist of a single cell. Yeast and 
bacteria are one-celled plants ; the amoeba is a one- 
celled animal. The single cell of such a one- 
celled organism must be able to carry on all the 
processes necessary for maintaining life. This 



CHROMOSOMES 

NUCLEUS — 

NUCLEOLUS -- J 




--CENTROSOME 

--CELL WALL 

NUCLEAR 

MEMBRANE 



Figure 1. — Simple Cell. 

type of cell is called a simple or undifferentiated 
cell. 

In multicelled organisms, cells vary in their 
size, shape, and number of nuclei. When stained, 
other differences can be seen under a microscope. 
Many cells are highly specialized. Specialized 
cells are those that perform a special function, 
such as muscle cells which contract, and epithelial 
cells of the skin which protect. A mass of special- 
ized cells that are similar in structure and function 
is called a tissue. An organ is a group of dif- 
ferent kinds of tissues combined to form a part 
of the body having a special function. 

One characteristic of cells is that they have a 
permeable cell wall through which fluids may 
pass. This is important because all body cells are 
bathed in tissue fluid from which they get the 
nourishment essential for life and growth. From 
the tissue fluid they absorb such things as oxygen, 
proteins, carbohydrates, salts, and water. 



ANATOMY AND PHYSIOLOGY 



Cells may be irritated and excited to activity bj 
mechanical, chemical, or nervous stimulation. 
Tins produce- muscular movements, or secretions 
such as the digestive juice- of the stomach. The 
stimuli are carried to the cell by nerves, or are 

caused by chemical substances thai reach the till 
through the blood and tissue fluid. 




Tissues 

Tissues, which are groups of specialized cells 
similar in structure and function, are classified in 
five main groups: 

1. Epithelial. — The free surface of the -kin: 
and Linings of the digestive, respiratory, and 
urinary tracts, of blood and lymph vessels, of 
serous cavities, and of tubules of such secreting 
glands as the liver and kidneys. 

2. Connective tissue. — The supporting tissue 
of the body, such as fat in meshlike cells under 
the skin, or cartilage in joints. 

3. Muscular tissue. — Voluntary muscle fibers 
moving the skeleton; involuntary muscle fiber- in 
the heart, blood vessels, stomach, intestine, and 
other organs. 

4. Blood and lymph. 

5. Nervous tissue. — The brain, spinal cord, 
and nerves. 

If you look at some of these tissues under a 
microscope, you will see that the cells of different 
tissues differ widely. Muscle cells are compara- 
tively large and shaped like long, .-lender rods; 
red blood cells are -mall, flat disk.-: and skin cells 
look like irregular blocks or scaler ( Sec illu-t ra- 
tions.) 

There are two kind- of muscle tissues in the 
body : 

1. Voluntary, or striated, which you can control 
by your will, such as the biceps muscle in your arm. 

2. Involuntary, or unstriated, over which you 
have no control by your will, such as the muscle 
of your stomach. (Heart muscle, composed of a 
special branched type id' cell, is involuntary, al- 
though it is striated.) 

Muscles, which are formed of cell- bound to- 
gether in bundles, are capable of being stretched 
and of contracting when stimulated. 




Figure 2. — Epithelial Tissue. A — Simple squamous B Colum- 
nar; C — Cubodiol. 







Figure 3. — Types of Tissue. A — Collagenous connective (Tendonl. 

B Cartilagenous; C — Connective (Aerolar). Lymphatic 

E — Bone. 





Figure 4. — Muscle Tissue. A — Voluntary; B — Involuntary; C — 
Cardiac. 



10 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Blood and lymph, though not actual tissues, may 
be considered as tissues consisting of free flowing 
cells in body fluids or the blood stream. 

Nerve tissue is composed of nerve cells, nerve 
fibers, and supporting tissue between the cells and 
fibers, which keeps them in their position. It is the 
most highly specialized tissue in the body, requir- 
ing oxygen and nutrition to a higher degree than 
any other body tissue. 

In the body, cells are the smallest building 
blocks. Groups of cells form tissues, and similar 
tissues form organs such as the heart, liver, and 
kidney. These organs are grouped together to 
form systems such as the urinary system, which is 
composed of the kidneys, the uretei'S (tubes from 
the kidney to the bladder), the bladder, and the 
urethra. 

Anatomical Terms 

«To assist in describing the body, certain ana- 
tomical terms are used, and for determining 
position and direction you should be familiar with 
the anatomical position of the body. 




MEDIAN 



SAGITTAL 




The anatomical position is with the arms hang- 
ing to the sides, the palms of the hands facing for- 
ward, and the body in an erect standing position. 
Here are terms with which you should be familiar : 

Anterior — toward the front or ventral side of 
body. 

Posterior — toward the back or dorsal side of 
body. 

Medial — nearer or toward the midline. 

Lateral — farther from the midline. 

Internal — inside. 

External — outside. 

Proximal — nearer the point of origin or closer to 
the body. 

Distal — away from the point of origin or away 
from the body. 

Superior — above. 

Inferior — below. 

Cranial — toward the head. 

Caudal — toward the lower end of the body. 

For convenience in describing the body and 
positions often used in placing a patient in bed or 
preparing him for a surgical operation, you should 
know the following anatomical postures: 

SUPINE 




PRONE 




LATERALLY RECUMBENT 




TRANSVERSE FRONTAL 

Figure 5. — Anatomical Planes. 



Figure 6. — Anatomical Postures. 

Erect — the normal standing position of the 

body. 
Supine — lying position of the body, face up. 
Prone — lying position of the body, face and 

trunk down. 
Lateral Recumbent — lying position of the 

body on either the right or left side. 



ANATOMY AND PHYSIOLOGY 



11 



THE SKELETAL SYSTEM 

";! 1 *::., >- ::: ^:x 

ments for tendons, muscles, and ligam. , 




SkuII 



Clavicle 
Scapula 



Manubrium | o 
Bodq [5 

Ziphoid J* 



— Humerus 



Innominate 

—Ulna 

Radius 

r Carpals 
-latacarpals 

^-Phalanges 
femur 

-Patella 

Tibia 
Fibula 



Tarsals 

Metatarsals 

Phalanges 



„..,:,.).,, »«*" by which m«U -•..< 

[ 8 made possible. 

" : '' ' , ,V„I a.Uth.»org».c»un. 

:;!::.-.': .. ^jess 

»(^**?ClK*S 1- 

^=SfflJSs,s£ 



ARTICULAR 
CAATH-A<ȣ 




l=P€RIOSTtU« 

2 = compact Bone 

3zMEDOLLARY CANAL 

4 = HARROW 

5= ARTERY 

6=NERVE 

7=VEIN 



— The H 











Figure 8.- 


-V 


man Skeleton. 












IHFOEJ 








ICB 




U.S. 












PORT. 











UClU'C o 



f a Typical long Bont. 



12 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



marrow. There are two types of marrow, red and 
yellow. Yellow marrow is chiefly fat; red mar- 
row is where red blood cells are made. 

At the end of the bones is a smooth glossy tissue 
to form the joint spaces; this is called articular 
cartilage (articular since one bone articulates 
with another or fits into another) . The outer thin 
membrane of bone is called periosteum. The peri- 
osteum is important in nourishing the bone with 
blood. Capillaries and blood vessels run in the 
periosteum and dip into the bone surface to supply 
the bone with blood. The periosteum also has 
highly sensitive nerves which make it the pain 
center of the bone. In cases of fractures it is the 
periosteum that gives the pain, not the bone itself, 
and it is from the periosteum that new bone is 
formed. 

Composition of bone. — Bone is both hard and 
elastic. Two-thirds of the bone is mineral mat- 
ter (lime salts), to give it hardness. One-third is 
organic matter, which contains gelatin and gives 
the bone elasticity. A child's bones contain more 
animal matter, so they are more flexible and do not 
break so readily. As age increases, however, the 
proportion of mineral matter increases and bones 
become more brittle. 

Classification of bones. — Bones are classified 
by shape as : 

Long bones — examples: the femur and the 
humerus. 

Short bones — bones of the wrists and ankles. 

Flat bones — the skull, the sternum, the shoulder 
blades, and the pelvic bones. 

Irregular bones — the vertebrae, the mandible, 
and the hyoid. 

Number of bones. — There are 206 different 
bones in a human skeleton. 

In a child there are more, but in later life some 
of the bones fuse together. 

THE SKULL 

The skull is the bony framework encasing the 
brain. It is divided into two parts, the cranium 
and the face. 

It is made up of 23 bones, 8 of which form 
the cranium and 15 the face. 

Cranial bones. — These bones are firmly united 
and fit snugly together. The lines between the 
bones where the adjacent bones meet are called 



__ Coronal 
suture 



ffO 



^ 



Panetaf 




Mastoid process 
Stqloid process 



Figure 9. — Skull, Lateral View. 




Figure 10. — Skull, Mid-Sagittal View. 



Frontal 



Sphenoid- 



Zqgomatic — 
(tlalar) 

Ethmoid 

Vo m i r- — ■ 




Parietal 

Temporal 
Lacrimal 
Nasal 
— Inf. turbinate 



Mandible 



Figure 11. — Skull, Frontal View. 



ANATOMY AND PHYSIOLOGY 



13 



sutures. The most important bones for you to 
know are the frontal bone which forms the fore- 
head, contains the frontal sinuses, and helps to 
form the eyesoeket and nasal cavity; the two 
parietal bones which form the roof of the skull OH 
each side; and t he occipital bone which forms the 
back or base of the skull. This bone has a large 
hole in it called the foramen magnum, which per- 
mit.- passage of the spinal cord IV the cranium 

into the spine. 

Facial bones. — Of the 1-"' hone- in the face, the 
ones that you should know are the twit maxillary 
hone- which form the upper jaw ami the wall- 

of the nose. In each of these is a Large cavity 

called the maxillary -inn-. These -iini-c- arc im- 
portant in the upper respiratory diseases. They 
frequently are infected following a common cold. 
The maxilli form the upper jaws as well. The 
mandible is a loose hone which form- the lower 
jaw. It is shaped something like a horseshoe and 
is the only hone in the skull that is movable. 
This, of course, is neces-ary for chewing. 

THE VERTEBRAL COLUMN 

The vertebral column, or spinal column, consists 
of 24 movable or true vertebrae, the sacrum, and 



Sup. Articular 
process 

Transverse 
process 



Pedicle 



Spinous 
process 




Intervertebral 
Disc 



.Transverse 
procass 

Pedicle 




Arch 



/^Vertebral 
0%f foramen 

Figure 12. — Typical Vertebra. 



> 12 thoracic 




umbar 



1 sacrurn 
1 coccqx 

Figure 13. — The Vertebral Column. 
the COCCyX Or tail hone. The spinal column is 

divided into five regions : cervical i neck i. thoracic 

(chest), lumbar (lower back), -a<ral. and . ■ 

geal (both in the pelvis). See figures 12 and 18. 

Classification of vertebrae. — The vertebrae are 
designed to serve as a bony protection for the 

spinal cord and the nerve- which arise from the 
spinal cord. Each vertebra haa a compact body, 
which i- the large aolid Begment of the bone in 
front. This body i- for support, not only for the 
spinal cord hut for the other organs of the body 
as well. Many of the main muscles of man are 
attached to the vertebrae. The hollow spa 
hole directly behind the body is for the spinal 
and the variou- facet- ami | are to help 

the vertebrae t<> move one on the other and for 
the attachment of the spinal muscll 

There are -even Cervical veitehrae in the i 

The first i- called the atlas because it supports the 

head. The -ecoml I- the axis, a- it is the one upon 
which the head turn-. These are the only named 
veitehrae: all others are numbered. The seventh 

cervical vertebra has an especially prominent pro- 



14 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



jection which can easily be felt at the nape of the 
neck. This makes it possible for doctors to count 
and identify the vertebrae above and below it. 

There are 12 vertebrae in the chest region. 
Tbese articulate with the ribs to form the back 
wall of the chest cage. 

There are five lumbar vertebrae. The sacrum is 
roughly triangular in shape and is formed by the 
fusion of five false vertebrae. The sacrum articu- 
lates on each side with the hip bone, and with the 
coccyx forms the posterior wall of the pelvis. 

THE THORAX 

The thorax is a cone-shaped bony cage formed 
by the sternum or breast bone and grouped carti- 
lages in front, 12 ribs on each side, and the bodies 
of the twelve thoracic vertebrae behind. It houses 
the heart and lungs, vital organs of circulation 
and respiration. 

The sternum occupies the middle of the upper 
part of the chest wall in front. It is attached to 
the clavicles (collar bones) and the cartilages of 
the first seven ribs. 



Acromion extremttq 

Acromion 
process 

Head 

Grcatar. — 
tobcrositq 

Bicipital 
groove 



Clavicle 



Radial fossa 
Lateral 




Sternal 

extremity 



Humerus = 



Lateral . /.,> fai 
cpicondqle— I^V^f 

Capitulum 



Coronoid fossa 
)_Medial epicondqlc 
■-Trochlea 



Figure 14. — The Shoulder Girdle. 



There are 12 pairs of ribs, which form a series 
of curved bones that support the chest wall. Be- 
hind they articulate with the thoracic vertebrae. 
In front each rib is provided with cartilage. 
The first seven ribs are attached to the sternum 
and so are called true ribs. The eighth, ninth, and 
tenth ribs are united by their cartilages to the 
cartilage of the seventh rib and are called false 
ribs. The last two ribs are free in front and are 
called floating ribs. 

THE UPPER EXTREMITY 

The upper extremity consists of the shoulder, 
the arm. the forearm, the wrist, and the hand. 
The bones that form the framework for the upper 
extremity are the clavicle, the scapula (shoulder 
blade), the humerus (arm bone), the radius and 
ulna, (forearm bones), the carpus (wrist bones), 
the metacarpus (bcnies of the palm), and the 
phalanges (finger bones). See figures 14 and 15. 

Clavicle. — The clavicle forms the front part 
of the shoulder girdle. It lies in a horizontal 
position just above the first rib and is shaped like 
a flat letter S. Because of its location and because 
it is close to the skin, the clavicle is often frac- 
tured as the result of falls. 

Scapula. — The scapula is a triangular shaped 
bone (see illustration). Its outer corner helps 
to form the shoulder joint, articulating with the 
humerus. 

Humerus. — The humerus extends from the 
shoulder to the elbow. It is made up of a head, 
an anatomical neck, a surgical neck, a shaft, and 
a distal extremity. The head articulates with the 
scapula. The distal end articulates with the 
radius and the ulna. 

Radius and ulna. — When the arm is in ana- 
tomical position with the palm facing forward, 
the radius is on the lateral or thumb side and the 
ulna is on the medial or little finger side. When 
the hand is pronated (palm down), the bones 
rotate on each other and cross in the middle. This 
makes it possible for you to turn your wrist and 
hand in opening doors and unscrewing bottles. 
The ulna joins the humerus and articulates with 
the radius at both ends. The radius articulates 



ANATOMY AND PHYSIOLOGY 



15 



Head— i 



Radial 



Tuberosity 



\- Olecranon 
process 

^Coronoid 
process 



Radios 



m 



Slqloid process 
of radios 

Navicular^ 

Capitate- 

Grealer- 

Multanguld 

Lesser. 

nuilan^alar 



?/ 



7/ A 



Ulna 



Capdulum 
/Stqioid process 
'Lunate 

Pisiform 

Triangular 

Hamate 

!i Metacarpal 



Phalanges 



Figure 15. — The Foreorm and Hand. 

with the humerus and with the ulna at both ('inl- 
and with some of the carpal bones. It helps Form 

the elbow, and the two hones can be felt at the 

wrist, the radius on thumb side and the ulna on the 
side of the little finger. 

Carpal hone-. There are eight carpal bones 
arranged in two rows. 

Metacarpal hones. — These are numbered one to 
live to cone-pond with the five fingers and the 
phalanges with which they articulate. 

Phalanges. — These are the small hones of the 
fingers. Bach finger has three bones, except the 
thumb which has two. The hone at the end of 
the finger is called the distal phalanx, the one 
closest to the hand the proximal phalanx, and the 
one in between, the middle phalanx. 



THE LOWER EXTREMITY 

The lower exl ivmit \ include- the hip. thigh, 
inkle, and foot, 'the hone- lhat make up 

the framework for the lower extremity are the in- 
nominate or pelvic hone I hip hone ). femur i I 
bone), patella (knee cap), tibia and fibula < le;_ r 
bones), tarsals i ankle bones), metatarsals (foot 
hone- 1 . and phalanges (toe bones). 

Innominate hone. — An Innominate hone has 
three part-, the ilium, the i-chium. and pubis 

The upper edge of the ilium i- important anatom- 
ically because it help- to locate important surface 
anatomy point-. For example, there i- a bony 
projection called the anterior superior -pi 

the ilium. Tin- i- the point at the front of the 
hip bone and 1- helpful in locating the appendix, 
for the appendix i- midwaj between that point 

and the navel. The acetabulum 18 a <np-haped 

Structure on th itside of the hip hone in which 

i- seated the hall like head of the femur. The 

two innominate hone-, together with the sacrum 
and the coccyx in the rear, form what is known 
as the pelvic girdle. It i- a deep basin designed 
to protect the organs of the lower abdomen, espe- 
cially the bladder, lower bowel, ami reprodu 
organs, 

Femur. — This is the longest hone in the body 

and. like other loiiL r hone-, i- made up of a -haft 
and two ends. The upper end i- ion in led and has 
a head which lit- into the acetabulum. It al-o ha- 
a neck, the part of the femur in<>-t frequently 

tured. and two processes for attachment of mus- 
cles, called the le--er and greater trochanters. At 

the lower end are two Don) promineiiie- tailed 
the lateral and medial condyle-. These articulate 
wit h the t ibia and the patella. 

Patella. — This i- a -mall oval-shaped hone 
overlying the knee joint, it i- enclosed within 

the tendon of the quadriceps muscle of the thigh. 
Hone- like the patella that develop within a tendon 
are know n a- - 

Tibia. — Tin- i- the larger of the two leg bt 

and lie- on the medial side. It- upper end articu- 
late- with the femur and with the fibula. It- lower 
end articulate- with the lain- (one of the hoi 
the foot i ami also with the fibula. A prominence 
easily felt on the inner side of the ankle i- called 
the medial malleolus. 



16 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Grcatar 
trochanter 



NecK 

■■>» Lesser 
•trochanter 



Laural — 

cpicondqle 

Lateral 
condqle 



Patellar 
surface 




Calcaneus 



-Medial , , 
epicondqlc 



_ Medial 
condqle 




—Talus 

—Navicular 
Cuneiform 



Metal 



arsdl 



tea Phalanges 



lateral — 
mallaolus 



Figure 16. — The Bones of the Lower Extremity, 



Ant. Superior X^;" 
Spine -\f$ ' 



Ant. Inferior 
Spine 



Pubis 



Obturator 
Foramen 




Iliac -.Crest 



Post. Superior 
" Spine 



Post. Inferior 
Spine 

Acetabulum 



Ischium 



Sap.AniN 
[liac spine 




Inf. Ant. 
Iliac spina 



Ischium 



Acetabulum 



Obturator 
foratran 



Figure 17. — The Innominate Bone, Lateral View. 



cocct^ 
Sqmph'qsTs Pub i s 

pubis 

Figure 18. — The Pelvic Girdle. 



ANATOMY AND PHYSIOLOGY 



17 



Fibula.— This is on the outer side of the lei:. 
The prominent portion of the lower end <>f tin- 
bone is called the lateral malleolus. It can be 
felt beneath the skin and helps form the ankle 
joint. 

Ankle.— There are seven tarsal hour- that form 
the ankle. The calcaneus is the name for the heel 
bone. 

Foot— Forming the sole and instep of the fool 
are the five metatarsals. These arc similar in ar- 
rangement to the metacarpal hones of the hand. 

Phalanges. — These are similar in number, 
structure, and arrangement to those in the Gingers. 

JOINTS 

Wherever two bones are attached to each other, 
a joint is formed. In a freely movable joint such 
as the knee joint or elbow joint, the ends of the 
bones are covered with a smooth layer of cartilage. 
The whole joint is enclosed in a watertight sac of 
membrane, containing a small amount of lubri- 
cating fluid. This enables the joint to work with 
little friction. The function of ligaments, which 
reach across the joints from one bone to another, 
is to keep them from getting out of place. When 
ligaments are accidentally torn, we call the injury 
a sprain; when hone- gel out of place, there is a 
dislocation. When the bones are broken or 
chipped, the injury is called a fracture. The dif- 
ferent types of joints in the body are: 



SUTuRAl LIGAMENT 



ARTICULAR 
CARTILAGE 




LIGAMENT 

FiBROCARTILfi&e 
OISC 



(immovable) 



SYNOVIAL 
MEMBRANE 



(slightly movable) 




UGAMCNT 



(friely movabie) 

Figure 19. — Typicol Joints (After Grays Anatomy). 



Immovable. — Bones of the skull, which 
rigidly interlocked ah.nL r lines thai are called 
-in urea 

Slightly movable joints. — Aa aeen between the 
vertebrae and in the symphysis pubis, where the 
hone- are held together by broad flattened d 
of cartilage and by ligaments. 

Freely movable joints.— Such is the knee. 
shoulder, hip. and elbow. Included under the 

movable joints are hinge joints— elbow and k: 

hall and socket joint shoulder and hip: gliding 

joints — wri-t and ankle: pivol or rotary joint — 
the axis rotation about the .it hi- ; condyloid joint- 
tin which an oval head of one bone lit- into the 
shallow depression of another)— the metacarpo- 
phalangeal joint-. 

Joint movements are of several tvp 

1. Flexion — bending the forearm on the arm. 
the leg on the thigh, or the fingers on the palm of 
the hand. 

l'. Extenswi — straightening or unbending, as 
in straightening the forearm, leg, or flngera 

■".. Abduction- moving an extremity away from 
the body, as in abducting the arm. 

4. Adduction- -bringing an extremity toward 
the body, as in abducting the arm. 

.'>. Rotation — turning the head. 

6. Pronation — turning downward, as in plac- 
ing the hand palm down. 

7. Supinatiott^-turning upward, as in placing 
the hand palm up. 

8. Eversion — turning outward. For example. 
turning the sole of the foot lateralward. 

'.». 1 in-, rsion — turning inward; as in turning the 

sole of the foot inward. 

MUSCLES 
The study of muscles, myology, is important, 

since all human activity i- carried on by muscl 

One half the weight of the human body is made 

up of muscle-. A man ha- more than 600 muscles 

large enough to be -ecu by the unaided eye and 

many thousand- so -mall that a microscope mu-t 
be used to -,.,■ them. Even if the body had no skin 

to cover H. mo-t of the skeleton would he hidden 



18 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



tc mpo ralis - 
massetzr 
sternocleidomastoid 
trapezius 
deltoid — 

pectoralis maj. 
latissimus dors 
rectus abdom 
biceps brachii 

serratus ant 
triceps brachii 
brachioradialis 
fexor carpi radial 
palmaris lonq 

ext. oblique 
inquinal liq 



tensor fasciae latae 
rectus femons 
vastus lateralis 

tibialis antarior 
pe rone us lonqus 



frontalis 

orbicularis 
oculi 

■orbicularis 
oris 




Figure 20. — Important Superficial Muscles, Anterior View. 

by one or more layers of muscle. The form the 
body takes is due largely to the muscles cover- 
ing the bones. 

All body motions are produced by muscle ac- 
tion — even to making your hair stand on end, for 
cold or fright causes contraction of tiny mus- 
cles in the skin and makes the hair stand up. 
During your lifetime there is never a moment 
when all the muscles are quiet. Although you may 
be relaxed and resting, your heart is beating and 
your lungs are breathing and muscles are at work. 
The muscles in the heart, the stomach, the intes- 
tines, and the arteries are at work even though you 
are not aware of it. 



Terms to Know 

In studying muscles, you will need to know a 
few terms such as : 

Muscle. — An organ to produce motion. 

Tendon. — A thin, strong, white cord which 
connects muscle to bone. Tendons make it pos- 
sible for muscles to apply their force at a con- 
siderable distance from their contracting part. 
For instance, many of the muscles that move the 
fingers and wrist are located in the upper part 
of the forearm. If it were not for lonjr tendons 
in the wrist and fingers, these parts of the body 
would be thick and clumsy. 

Ligament. — A strong band of tissue which holds 
bones together or organs in place. 



i-Vtir temporalis 
n\V^|]; occipitalis 



sternocleidomastoid 
trapezius 

deltoid 




latissimus dorsl 

triceps, lonq head 
lateral head 
medial head 



brachioradialis 
xtcn. carpi radialis 
us & brevis 

ex. carpi ulnans 
ten. carpi ulnaris 
exten.diqitorum 
communis 



lotibial band 

biceps femoris 

semitendinosus 

semimembranosus 

qracilfs 

qastrocnemius 

soleus 
achilles tendon 



Figure 21. — Important Superficial Muscles, Posterior View. 



ANATOMY AND PHYSIOLOGY 



19 



Fascia. — Fibrous tissue surrounding muscles 
and keeping them in place during movement. 

Origin.— Tin' more fixed attachment of a 
muscle. 

Insertion. The more movable attachment of b 
muscle. 

Fatigue is produced w hen the muscles have con- 
tracted repeatedly, and waste products have ac 
cumulated in the muscle cells. 

A motor nerve is the nerve which can-.- a 
muscle to move. 

Rigor mortis is the stiffening of muscles some 
time after death. 

TWO TYPES OF MUSCLES 

There are two kinds of muscles, depending on 
whether we control the muscle or it works auto- 
matically. The kind that works whether we wish 
it to or not is found in the heart, the -tomach. the 
intestines, the arteries, and other organs. These 
aiv called involuntary muscles (cardiac and 
smooth muscles). 

The other muscles, which work under our will, 
are found chiefly in the face, neck, limbs, and 
outer parts of the trunk, and attach to the skeleton. 
A man cannot by his own choice -top his heart 
pom beating or start it if it stops, but he can move 
an arm or a leg. These muscles, which move the 
skeleton, are called voluntary, striated, or skeletal 
muscles. 

In passing it is interesting to note that this i- 
evidence that your Creator gives you life and op- 
erates your body automatically, hut gives you 
the privilege of choosing what you will do with 
the muscles that you yourself can move. Your 
life depends on muscle action that you cannot 
control, while tin 1 kind of work you do in life de- 
pends on how you u -e the inn. -de- \ on can control. 

How Muscles Are Made 

All muscles are made up of long, -lender cell-. 

"When muscles work, these cell- become shorter 
and thicker, and a similar change takes place in 
the whole muscle. For example, bend your fore- 
pin on your arm now and squeeze it tight: note 



how your biceps muscle thicken- and get* lend. 

This i~ contracti >f a voluntary muscle. 

A typical skeletal, or voluntary, muscle 
fleshy ma— of elongated muscle fibers held 
gether in a casing of white fibrous tissue and 

Supplied with a nerve which make- it work, 

These nerves are called motor nerves, since they 

Bend out impulses that actually -tart the nni-de 

motor w Inch make- 1 he body move. 

At one end of BOme muscles are long white ten- 
don-, something like guy wire-, which extend i" 
your fingers and your feel. Thi- not only make- 

for graceful movements of your fingers, but also 

reduces the amount of bulk that Would he lie 
-ar\ it muscles had to extend around your fingers. 

Muscles seldom act alone, but usually in muscle 
groups, ami these muscle groups are held together 
by white fibrous tissue called fascia. 

When a muscle cont racts n uses energy ami does 
work. In the process it must have fuel in the form 
of sugar called glucose. < llucose is produced dur- 
ing the digestion of nearly all forms of starch 

or sugar, and it occurs naturally in nian\ foods. 
After repeated contraction, mu-de cell- break 
down and inii-l he replaced. The repair material 
for wornoiit muscle cells is protein, a suhr-taii.e 

that occur- in large amounts in meat, eggs, beans, 
milk, and similar foods. 

When a muscle contract- it produces chemical 

waste products (carbon dioxide, lactic acid, and 

acid phosphate), which make the mu-de more ir- 
ritable. If contraction i- continued the inn - 

will finally cramp up and refuse to re. This 

condition i- known a- fatigue. If it i- can 
too far. the inu-de cell- will not recover and 

permanent damage will result. Muscles, there 
fore, need rest to allow the blood t" carr] away 

the wa-te material- and bring in fresh gin© 

oxygen, and protein i<> restore the muscle proto 
plasm and the energy that was used. 

The importance of exer< ise for normal muscle 
activity i- dear, hut i ■ nni-de -train i- 

damaging. For example, if a gasoline motor 

-land- idle, it eventually becomes in-ly and U 
less. Similarly a muscle cell that doe- Dot work 
becomes weak and flabby. On the other hand, a 
motor that i- never allowed to atop and 
forced to run too fast or do too much heavy 



20 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



work soon wears out so that it can no longer be 
repaired. In the same way, a muscle cell that is 
forced to work too hard, without proper rest, will 
be damaged beyond repair. Violent exercise is 
never good. Exercise should be adapted to the 
individual and should never be carried to the point 
of extreme fatigue. 

During exercise, massage, or performance of 
ordinary activities, the blood supply of muscles 
is increased. This brings in fresh food materials, 
carries away waste products more quickly, and 
enables the muscles to build up and restore their 
efficiency and tone. 

When a muscle dies it becomes solid and rigid 
and no longer reacts. This stiffening, which oc- 
curs from ten minutes to seven hours after death, is 
called rigor mortis. 

How Muscles Work 

Muscles do three things for us : 

1. Provide movement, as in peristalsis in the 
intestines. 

2. Maintain our posture through muscle tone, 
as in the muscles of the head, neck, and shoulders, 
which keep the head erect. 

3. Produce heat. Chemical changes that take 
place during muscle activity, such as mild exercise 
on cold days, keep us warm. 

BURSAE 

Bursae are small fluid-filled sacs which overlie 
joints where pressure may be exerted between the 
skin and the bone, between bone and tendons, and 
between muscles or ligaments and bones. Some 
of these frequently become inflamed. Among 
them are : 

Subacromial bursa in the shoulder, located be- 
tween the deltoid muscle and the head of the 
humerus. 

Prepatellar bursa just below the kneecap. In- 
flammation here, with forming of fluid, is known 
as "housemaid's knee'' because it occurs frequently 
in charwomen who mop floors while kneeling. 

Olecranon bursa over the elbow. When in- 
flamed, this is known as "student's elbow," because 
students frequently lean on their elbows and irri- 
tate this little fluid-filled sac. 



SPECIAL MEMBRANES AND GLANDS 

Membranes are the lining tissues of the body, 
and are serous, synovial, mucous, and cutaneous. 

Serous membranes are so named because they 
are moistened by a fluid resembling the serum of 
blood. Serous membranes proper are found in 
fluid-filled sacs which cover the lungs, heart, or- 
gans contained in the abdominal cavity, brain, 
and spinal cord. 

Synovial membranes are those lining joints and 
bursae. These, too, contain fluid. 

Mucous membranes are those lining the inside 
cavities of the body, such as the mouth, intestines, 
lungs, bronchi, gallbladder, kidneys, and urinary 
bladder. 

Cutaneous membrane is the outer covering of 
the body, the skin. This is the largest organ of 
the body and important for its protective function. 

GLANDS 

Glands secrete something essential to the body, 
or excrete waste materials which, if retained, 
might be injurious to the body. 

There are simple glands such as the salivary 
glands, which secrete saliva into the mouth, and 
ductless glands that secrete hormones directly 
into the blood stream, their secretion not requiring 
a duct. The island cells of the pancreas, which 
make insulin, are examples of ductless glands. 

THE BLOOD AND THE BLOOD 
VASCULAR SYSTEM 

Blood is the fluid tissue that circulates through 
the blood vessels in the body, and blood, which 
the heart pumps rapidly round and round the 
bod}' through miles of arteries, veins, and capil- 
laries, does many things to keep us alive and 
healthy. It carries the necessities of life — oxygen, 
water, and food — to all the cells of the body. In 
an average adult weighing 160 pounds, the 6 quarts 
of blood in his body amount to about one-twelfth 
of his body weight. 

Blood consists of plasma, red cells, white cells, 
and platelets. The cells flow freely in the clear 
fluid portion, blood plasma, which carries them 
to the body cells. 



ANATOMY AND PHYSIOLOGY 



21 



Blood enables the eella of the body t<> breathe by 
bringing them oxygen from the lungs and by car- 
rying carbon dioxide from the cells back to the 
lungs, where it is expelled. 

Blood carries food from the intestines to the 
body cells, and carries away waste products to 
kidneys or bowels, where they are removed from 
the body. 

Blood furnishes water to the cell tissues. 

Blood distributes heat produced by the working 
muscles: and because of its water content and 
mobility, blood serves ns a temperature regulator 

for the body. 

Actually blood serves as a conveyor belt to carry 
food, hormones, oxygen, and all the essential nu- 
trients for life. In one sense the blood stream is 
a river of life, carrying food, water, and oxygen 
to the hotly cells. In the other direction the blood 
stream serves as a sewerage system, carrying 
away body wastes from the eells to the organs of 
excretion — the kidneys, bowel-, lungs, and >kin. 

Blood also carries white blood cell- and anti- 
bodies. The latter are complex chemical sub- 
stances which serve as a constant bodyguard 
against infections and other diseases. 

Your blood stream has it- own repair Bystem. 
If a blood vessel is ruptured, the blood platelet - 
help to form a clot and stop the bleeding. 

The blood stream, which i- slightly alkaline, al-o 
has an important function in keeping the acid-b 
equilibrium or balance of the body. 

Healthy blood (plasma and blood cells) i- T8 
percent water and 22 percent solid-. 

Blood plasma, the Liquid portion of the blood, 
is a clear straw-colored liquid, slightly alkaline. 
Blood plasma, in contrast to blood Berum, is the 
liquid part of blood before coagulation take- place. 

If blood escapes from it- \e— el. it usually COagU- 
lates or clots. As the clot form- it -brinks and 
squeezes out a clear, yellowish Liquid known as 
blood serum. Blood serum may be defined a- 
the liquid part of blood after coagulation take- 
place. 

Lymph is the liquid plasma which has passed 
through the wall- of capillaries into the ti— ue-. 

Under the micro-cope, blood is seen to contain 
cells suspended in a liquid, ami these cell: — red 
cells, white cell-, platelet- comprise about L5 per- 
cent of the blood. The remaining liquid portion 

211800°— 53 — s 



i- the blood plasma, 90 to 98 percent of which is 

water and about '•• percent -olid-. 

Under the micro-cope, red cell- look like red 
discs or saucers with pale centers. Thej are usu- 
ally all about (he BamC BUB, in a healthy blood 

Bmear. 

White cell- are larger than red cell- ami have 
well formed center-, or nuclei, the essential part 
of the cell. 

Platelets are colorless cell- with no nuclei, and 
var\ greatly in M/.e ami -hape. 

ACID-BASE EQUILIBRIUM 

The normal body proo nit in acid end 

product- which tend to make the blood less alka- 
line. Oxidation in all ti— ue- produces carbon 
dioxide, which i- acid : mu-ciilar contraction make- 
lactic acid: the oxidation of protein, which con- 
tains sulfur and phosphorus, produce- sulfuric 

and phosphoric acid-. 

In spite of the formation of BUch acid BUbstanceS 

in the blood, it remains remarkably uniform ami 
slightly alkaline at all time-. Variations m re 
tions greater than from pll 7.0 to JTJJ are almost 
never observed, 

By some mysterious mean- the body maintains 
this acid-base balance by quickly neutralising 
acids that are formed in the tissues ami promptly 

eliminating them through the lungs or kidneys, 

or neutralizing the acid- by Bubstances in the blood 
called buffers. A buffer is anj substance which 

tends to prevent the reaction of a BOlution from 

changing on the addition of acids or alkali 

When this neutralizing mechanism i- oven 
by taking in too much acid or alkali or a- a result 
of disea-e. there occur- a notable change in the 
blood reaction. The resulting condition- 
known as acidosis or alkalosis. Any Buch change 
of reaction i- fatal unless quickly corrected Of 

compensated. 

IMMUNITY 

The body*- deft linst infection i- called 

immunity. This i- the body'- ability to prot 
it-elf against injury by bacteria or poisonous I 

teiial product- called toxins. In this defense the 
blood and lymph play an important role. The 
blood plasma carries antibodies which neutralize 
toxin- and help knock out invading bacteria and 



22 



HAND&OOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



viruses. The blood also contains white cells which 
serve as soldiers to kill enemy bacteria. 

When a substance is injected into the body, it 
stimulates an opposing substance. The substance 
injected is called an antigen and the opposing 
material in the blood stream is called an antibody. 
Foreign substances such as bacteria and their 
toxins, when entering the bloodstream, act as anti- 
gens and stimulate the blood plasma to form spe- 
cific antibodies. These antibodies are of several 
types, such as bacteriolysins which kill the bacteria 
themselves, agglutinins which cause bacteria to 
clot, precipitins which precipitate bacteria and 
antitoxins which neutralize bacterial poisons. 

White blood cells, with their power of move- 
ment, surround bacteria and destroy them. In the 
fight, white blood cells themselves are destroyed, 
forming pus. 

TRANSMISSION OF HORMONES 

Hormones, the secretions of ductless glands, are 
internal secretions which enter directly into the 
blood stream. They are then carried to the parts 
of the body where their effect is produced. As a 
ride, the ductless glands are not located near the 
organs that their hormones affect, so their hor- 
mones are carried by the blood stream to the dis- 
tant organs for their actions. By this distribution 
of the hormones throughout the blood stream, a 
harmonious coordination is accomplished in the 
body. 

BLOOD COAGULATION 

To protect the body from excessive blood loss, 
blood has its own power to coagulate or clot. Cir- 
culating blood will not clot, but upon escaping 
from the blood vessel it begins to clot immediately. 

As soon as blood escapes from its vessel and 
strikes the air or the skin, a strange chemical re- 
action sets in. The clot formed is at first fluid but 
soon becomes thick and then "sets" into a soft 
jelly, which quickly becomes firm enough to act 
as a plug. 

This plug is the result of a swift, sure mecha- 
nism which changes soluble blood protein, fibrino- 
gen, into the insoluble protein, fibrin, whenever 
injury occurs. 

Necessary elements for blood clotting are cal- 
cium salts, a substance called prothrombin formed 



in the liver, and blood platelets which break up to 
set off the clotting mechanism. 

Once the fibrin plug is formed, it quickly en- 
meshes red and white blood cells and draws them 
together tightly. Blood serum, a yellowish clear 
liquid, is squeezed out of the clot as the mass 
shrinks. 

Formation of the clot closes the wound and pre- 
vents blood loss. A clot also serves as a network 
for the growth of new tissue in the process of 
healing. 

Normal clotting time is 3 to 5 minutes, but if 
any of the substances necessary for clotting are 
absent severe bleeding may occur. 

Hemophilia is an inherited disease in which the 
patient's platelets are too tough to break up and 
set off the clotting mechanism, so blood clotting 
is delayed and even a trivial wound may cause 
severe and dangerous bleeding. 

THE CELLS OF THE BLOOD 

Red blood cells are circular red discs or saucers 
with pale centers and no nucleus, which are 
formed in the bone marrow. They are about 
% 2 oo of an inch in diameter, and the adult male 
has about 5,000,000 per cubic millimeter of 
blood. The red color of red blood cells is due 
to hemoglobin, an iron-protein substance which 
combines with oxygen and carries it from the 
lungs to the body cells. Hemoglobin also has the 
power of readily combining with carbon dioxide 
and carrying it from the body cells to the lungs. 

At a certain point in the development of the 
red cell, hemoglobin is added. This hemoglobin 
consist of iron-containing red pigment (heme) 
combined with a protein substance (globin). It 
is the hemoglobin that gives the red cells the abil- 
ity to pick up oxygen in the lungs. Iron is a key- 
stone raw material required by the red cell fac- 
tories. Part of this "scrap iron" is salvaged from 
broken-down red cells; the rest comes from our 
food. If iron is lacking, the amount of hemo- 
globin in the red cells is lowered, and later the 
number of red cells in the blood stream is reduced. 
The best food sources of iron are meat (especially 
liver), eggs, green vegetables, and whole-grain 
bread and cereals. 



ANATOMY AND PHYSIOLOGY 



23 



Red blood cells live aboul 100 to 120 days in 
your body. When you think of the rugged life 
thai ;i fragile little blood cell lives, there are rea- 
Bons for its short life span. This delicate cell has 

to withstand constant knocking around as it is 

pumped into the arteries by the heart. It travels 
through blood vessels at high speed, bumps into 
other cells, bounces off the walls of arteries and 
veins, and squeezes through narrow passages; n 
must adjust to continual pressure changes. Frag 
mentsof red blood cells are found in the spleen and 
other body tissues. The spleen is the graveyard 

where old, wornout cells are removed from the 
blood stream. 

In the oxygen-carbon dioxide exchange the red 
cells deliver oxygen to the tissues. Usually only 

1 .-, or ' , of the oxygen load IS released, as the tis- 
sues are not able to absorb more than they need at 
the moment. The rest of the oxygen remain- in 
the hemoglobin as an emergency reserve supply. 

Interestingly enough, the average man has 

(80, 1,000,000,000) redcellsin his blood, or about 

2^& trillion per pint, Women have slightly fewer 
red cells, about l'7'o trillion. Under emotional 
-t reSS or st renuOUS exercise, the number of red cells 
increases. Abo. at high altitudes or high temper- 
atures they are more numerous. 

An important thing to remember about intra- 
venous medication is this: The amount of salt in 
the blood stream is about nine-tenths of 1 per- 
cent or 0.9 percent. This is called isotonic saline 
and has the same osmotic pressure a- tissue fluid. 
If the percentage of salt i- less, the red eel]- will 
absorb water, swell, and burst Some bacterial 
products cause this. These are called hemo- 
lysins, causing hemolysis or destruction of the red 
cell. 

If, on the other hand, the salt solution is above 
normal concentration, it will draw water from the 
red cells and cause them to shrivel up and shrink 
and become crenated (krinkled). 

Arterial blood is bright red because its hemo- 
globin is combined with oxygen, and the blood 
in the veins is dark red because the hemoglobin has 
•liven off its oxygen and exchanged it for carbon 
dioxide. 

White Blood Cells 

"White blood cells or leukocytes are made in the 
bone marrow and in certain lymphoid tissui 



the body. There i- onlj one white cell to everj 
600 red cells. These white cells are important foi 
protect ion of the bod} against d 

They have the ability to move and crawl through 
little openings in the blood vessels, to engulf solid 

particles, and to attack bacteria. Since white cellfl 

can reach almost any part of the body, thej travel 
from place to place a- the} an- needed. By 
squeezing through crevices in the walls of capil- 
laries, white cells are able to move out of the blood 

1 and into the bod} tissue to reach the place 

of injury or infection. When your body 
tacked by an invading disease, the white cells close 
in. One group, the neutrophils, fight the ba< 
by eating them. As many as twenty bacteria have 
been found in-nle one attacking white cell. Other 

white cells clean up after the neutrophils, !■/. 

inir dead .ell-, pigment, and other debris. If the 
attacking white cell- are inadequate to ward off 
the infection, additional forces are called out. The 
cell-forming organs of the body L r «'t the "alarm" 
and release reserves into the blood. This elevates 

the normal white count of 6,000 to 8,000 white 
blood cell- per cubic millimeter to greater num- 
ber-, often 15,000 to 20, and even higher. This 

increase in the number of white cell- in the blood 
Stream is usually an indication of infection and is 
known as leukocytosis. It i- also seen in malignant 
growths and poisonings. 

Certain virus diseases cause a drop in the num- 
ber of white blood cell- I clow the normal : this is 

called leukopenia. It is al-o found in some un- 
complicated infection-, and when the patient is 
so weak and exhausted that he cannot mu-ter 
enough white blood cell- to fight the infection. 

White «cll- are divided into three distinct 
groups by their appearance under the microscope. 
Granulocytes are those having divided nuclei ami 

granules when they are stained. Lymph- 
are dark-staining cell- having a large nucleus, and 
are derived from lymphoid tissues. Mono 
are similar t<> lymphocyte-, having a large nucleus 
and pale cytoplasm. There are three variet 
granulocytes, called neutrophils, eosinophils, and 
basophil-. All of these are known as polymor- 
phonuclear, or "poly-" for -hort. by the labora- 
tory technician. 

Blood smears are stained and examined for 
various white blood cells, bv a "differential count." 



24 



HANDBOOK OF THE HOSPITAL CORPS', UNITED STATES NAVY 



In acute infections the number of "polys" may 
increase, giving the doctor an index of the 
severity of the infection. Other white cells in- 
crease in leukemia (cancer of the blood), infec- 
tious mononucleosis, and other diseases about 
which your pathologist will tell you. 

Platelets 

Blood platelets, or thrombocytes, are round bod- 
ies in the blood that contain no nucleus but only 
cytoplasm. They are smaller than red blood cells 
and number from 300,000 to 800,000 per cubic 
millimeter of blood. They are essential for blood 
coagulation or clotting, since they mix with fibrin 
to form a firm clot. 

THE BLOOD VESSEL SYSTEM 

The blood vessel system is a closed circulation 
of the blood in vessels which begin at the heart 
and extend to the arteries, the capillaries, and the 
veins. This closed system of tubes, called blood 
vessels, circulates the vital oxygen-carrying blood 
to all parts of the body. The heart is the muscle 
pump which propels the blood through the 
vessels. 

The heart is a hollow muscle located in the 
front and center of the chest between the lungs, 
with a large part of it lying directly behind the 
sternum. It is about the size of a closed fist 
and closely resembles a strawberry in shape. The 
base of the heart is upward toward the neck, and 
the apex, or point, is downward and to the left. 

The heart is enclosed in a membranous fluid- 
filled sac, the pericardium. The fluid lubricates 
the outside of the heart as it beats. The inside 
of the heart is lined with a delicate serous mem- 
brane similar to that of the blood vessels. 

The muscle of the heart is striated but invol- 
untary, and the muscle fibers spiral and inter- 
twine with one another, so that the heart con- 
tracts with a wringing motion to squeeze the 
blood into the blood-vessel system. 

Inside, the heart is divided into chambers, two 
upper receiving chambers, the auricles, and two 
lower ejecting chambers, the ventricles. These 
four cavities are called the right and left auricles, 
and the right and left ventricles. The wall of 
the left ventricle is thicker, since it does more work 
than the right ventricle. 



Between the auricles and the ventricles are 
valves which close when the heart contracts. This 
is to prevent a backflow of blood into the auricles. 

The heart has its own system of blood vessels 
called right and left coronary arteries and veins. 
It is under the control of two sets of nerves 
which are in delicate balance, the vagus nerve 
which keeps the heart beating at a slow regular 
rate, and sympathetic nerves which speed it up 
under times of emergency. The central nervous 
system can regulate the speed of the heart beats, 
but it cannot cause the contractions of the heart. 
Their cause is still a mystery. 

The heart action consists of wavelike contrac- 
tions, beginning in the auricles and passing to the 
ventricles. The contractions are followed by dila- 
tions, and the two conditions alternate. 

The normal heart rate is about 72 beats per 
minute. — This varies with age, weight, sex, the 
amount of exercise, and temperature of the in- 
dividual. 

Contraction of the heart is called systole and 
is the period of work ; dilatation, or diastole, is the 
period of rest or relaxation. 

A complete cardiac cycle is the time it takes 
from the appearance of one heartbeat to the next. 

Arteries are elastic tubes that carry blood from 
the heart to the body. They have an inner 
lining of silky white tissue, a middle muscle layer, 
and an outer elastic tissue layer. Arteries have 
their own nerve supply from the autonomic 
nervous system, by which the size of the arteries 
can be varied by opening them up (dilatation) 
or making them smaller (constriction). The 
smaller arteries are called arterioles. 

Capillaries are tiny vessels at the end of the 
arteries, which feed the blood back into the veins. 
They have very thin walls and communicate with 
each other and form a dense interlacing network 
in all parts of the body. As the blood passes 
through the capillaries, it takes up the various 
waste products that are to be carried away in the 
veins and gives oxygen to the tissues. This ex- 
change takes place through the very thin walls 
of the capillaries. 

Veins are hollow elastic tubes that carry blood 
back to the heart. Similar to the arteries, their 
walls are thinner, with less muscle tissue. Veins 
have valves which prevent the backflow of blood. 



ANATOMY AND PHYSIOLOGY 



25 



They begin as tin y venules Formed From capillaries 
which have joined together much as tiny rivulets 
connect and form a small stream, 

THE CIRCULATION OF THE BLOOD 

If yon think yon are overworked, jusl think 
of this: Every day your heart beats L00,800 times 
and your blood circulates a total of 1,440 

times, while your lungs inhale 138 cubic feet of air. 

And you're complaining I Think of your heroic 

heart and lungs. 

Now let ns trace the circulation of the hlood 
from the heart through the body and back again 
to the heart. The logical place to Btart is as the 

impure venous hlood enters the heart at the 

right auricle (receiving chamber) and passes into 

the right ventricle. As the righl ventricle con- 
tracts, the tricuspid valve between these two cham- 
bers closes to prevent a blackflow of hlood. Then 
as the hlood is forced from the righl ventricle, it 
opens the -emilunar valve- in the pulmonary 
artery. The pulmonary artery divides into two 
branches, one going to each Inn-:, where it divides 
into smaller arteries, arterioles, and capillaries 
and finally reaches the tiny air sac- | alveoli) of 
the lungs. 



Aort, 



V 



Pulmonary Valve 

Sup. Vena Cava 
\ 



Pulmonary Art. 

Aortic 
iValva 



Pulmonary 
Veins 



Bicuspid 
Valve 




Inf. VenaCava 
Tricuspid Valve 



Endocardium 
Myocardium 
Cpicardium 



Figure 22. — Diagram of the Heart. 



During its circulation through the lungs, the 
hlood takes on oxygen and i- returned through 

-mall vessels to the four pulmonarv veins, two 
from each Iiiiil'. which linally empty into the left 
auricle of the heart. Tlii- circulation from the 
right -ide of the heart to the left -ide of the heart 
i- called the pulmonary circulation of the hlood 
and i- designed to purify it. A- the blood 
passes through the lungs, it gives up carbon 
dioxide and takes on fresh oxygen. Thus fresh* 

e lied, the hlood lei Ulli- bright crilu-oll to the heart. 
The marvel of the pulmonary circulation i- that 

it take- only LOseconds of time to accomplish this 

pnri fyinir process. 

From the left auricle (receiving chamber) the 
hlood passes to the left ventricle through the 

bicuspid or mitral valve. A- the left ventricle 
contract- it -nap- the mitral valveclosed and op. •li- 
the aortic semilunar valves into the aorta. Once 
in the aorta, the blood flow- through it- arterial 

branches to .-mailer arteries, to arterioles, to cap 

illarie-. and to e\ci \ part of the hodv. It i- then 

returned by the capillaries to the vein- ami finally 
reaches the right auricle through the superior vena 

cava and the inferior vena cava, the largest Veins 
in the hodv. 

The pulse that you feel in yOUT wri-t i- formed 

by the contraction of the left ventricle which foi 

the hlood into the arteries and caUSCS a wavelike 

expansion of the arteries which is synchronous 
with t he heartbeat. 

It takes ahout 1 minute it'.u seconds) for the 
blood leaving the heart to return after making a 
complete circuit of the hodv. 

A- you listen through the doctorV stetho- 
scope to the beating "f your own heart, you will 
hear a Steady rhythmic lubb-dupp, lubb-dupp. 

Thi- i- the sound of hlood coursing through the 

valve- and chambers of the heart and the sound of 
the closing of the valve-. 

In 24 hour- your heart and pump- out 

again some 10,000 quarts of blood, and expends 
enough energy to raise ■ 160-pound man to the 
height of the Empire State Building. In 7 

vour heart will beat - M - billion time- without a 

single shutdown for repairs. Though your heart 
weighs hut '.„„ of the body weight, it requ 

for itself 'jo of the hlood in circulation. 



26 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



<zxt. jugular 
int. jugular 



subclavian 



brachial 



Common carotid 

innominate A 



axillary 




HI 

Figure 23. — Arteries and Veins of Torso. 



ANATOMY AND PHYSIOLOGY 



27 



BLOOD PRESSURE 

Blood pressure is the force your heart exerts 
to push the Mood through the arteries. The high- 
est pressure is called systolic blood pressure since 
it Is caused when ilif heart is in Bystole, or con- 
traction. A certain amount of blood pressure is 
maintained in the arteries even when the heart is 
relaxed and this is the diastolic blood pressure 
since it is presenl during diastole, or relaxation, of 
the heart. 

Normal blood pressure for young adults is: Sys- 
tolic, 120 nun. of mercury; diastolic, 7" to '.mi mm. 
of mercury. 

Pulse pressure is the difference between the 
systolic and the diastolic pressure. For example, 
a person having a blood pressure <>f li'n so would 
have a pulse pressure of 40. 

THE BLOOD VESSELS 

The system of arteries and arterioles is similar 
to that of a tree, with the aorta a- a trunk, the ar- 
teries as large branches, and arterioles as small 
twigs. The blood circulates from the aorta to the 
arteries and then the small arteriole-. In some 
cases the small arterioles unite in what is known 
as an anastomosis, as they do in the palm of the 
hand. 

The aorta is the large tubelike structure which 
arises from the left ventricle of the heart and 
arches upward around the left lung and then down 
along the spinal column through the diaphragm. 
Along the way it gives <>ll arteries to the head, 
neck, arms, chest, and abdomen, before finally 
dividing to send arteries down both lower ex- 
t remit ies. 

The aorta also sends small branches, called 
coronary arteries, to the right and left sid( 
the heart, to nourish the heart muscle. 

There are certain branches of the aorta with 
which you should he familiar since these often 
musl he compressed to prevent hemorrhage, and 
you will later learn in first aid the pressure points 
which must he held if severe hemorrhage is to he 
avoided. Three large arteries arise from the 
aorta as it arches over the left lung. The first of 




ARTERIES SUPERFICIAL VEINS 

Figure 24. — Arteries and Veins of the Upper Extremity. 

these branches is the innominate artery, which 
divide- into t he right Bubclai ian artery, to supply 
the right arm with blood, and the right common 

carotid, to supply the right side of the head. 

The next large branch is the left common ca 
rot id. which supplies the left Bide of the head. 
The third large branch from the arch of the aorta 
i> the left subclavian, which supplies the left arm 
with blood. On your diagrams you -hould learn 
the location of the pre— nre points where the-e 
arteries can he compressed. 

The carotid arterie- divide into internal and 
external branches — the external BUpplying the 
muscles and -kin of the face, the internal supply- 
ing the brain and the e\ 

The subclavian arterie- are BO named because 
they run underneath the clavicle (sub meaning 
under, and clavian. clavicle). They BUpply the 
upper extremity ami give oiT branches to the I 

the chest, the neck, and even the brain via the 
spinal column. 

The large artery going to the arm is called the 
axillary. This eventually divide- into the ulnar 
and radial arteries. The radial artery is the one 



2? 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



at the wrist which you will feel to take the pulse 
of your patients. 

The aorta as it passes into the chest is called the 
thoracic aorta and gives off branches to supply the 
lungs, the chest wall, and the heart. 

The abdominal aorta gives off branches to the 
abdominal viscera, including the stomach, liver, 
spleen, kidneys, and intestines. It finally divides 
into the right and left common iliacs which send 
large arteries to the lower extremities. On en- 
tering the thigh, the artery is called the femoral 
artery, and here again, on the inside of the thigh, 
is a pressure point that you should learn, for 
this artery is frequently injured in fractures and 
must be compressed with a tourniquet to prevent 
hemorrhage. 

Lower down in the leg the artery becomes the 
popliteal. Here it is located just behind the knee 
and can be compressed against the bone of the tibia 
or lower end of the femur. 

Since arterial blood arises at the heart, we trace 
arteries from the heart, but to return blood to 
the heart we trace veins from their smaller ex- 
tremities called venules, back through the larger 
veins. There are three main sets of veins in the 
body, called the pulmonary — those from the 
lungs; the systemic — those from the rest of 
the body other than the digestive system ; and the 
portal system — those returning blood from the 
intestines, spleen, and liver. 

The pulmonary veins are four, returning blood 
from the lungs to the left auricle of the heart. 
These are the only veins in the body that carry 
freshly oxygenated blood. 

The systemic veins are divided into deep and 
superficial. The deejo veins are usually located in 
the muscle or internal organs ; the superficial veins 
lie just under the skin. 

The large superficial veins of the head are called 
the external jugular veins. They drain blood from 
the scalp, face, and neck and finally empty into 
the subclavian veins. 

The veins which drain the brain itself and in- 
ternal facial structures are called the internal 
jugular veins. These, too, combine and finally 
empty into the innominate vein and superior vena 
cava. 




femora lis 



_ stealer 
saphona 



lesscr_ 
saphcna 




ARTERIES 



SUPERFICIAL VEINS 



Figure 25. — Arteries and Veins of the Lower Extremity. 

The superficial veins of the upper extremity 
begin at the hand and extend upward. There is 
one set of veins with which you should be familiar, 
called the median cubital or median basilic veins, 
as they cross the elbow. These are the veins most 
commonly used for intravenous injections. 

In the lower extremity there'is a superficial vein 
called the long saphenous, which starts on the inner 
side of the foot and runs up the inside of the leg 
and thigh to join the femoral vein in the groin. 
This vein is sometimes used at the ankle for in- 
travenous injections. In persons who do pro- 
longed standing, such as barbers, surgeons, and 
housewives, this venous system often becomes 
varicose and needs to be tied off at the groin or 
other places to prevent varicose ulcers from 
forming. 

The femoral vein is the large deep vein of the 
thigh. 



ANATOMY AND PHYSIOLOGY 



29 



Hie portal system of veins is thai which drains 
the blood from the stomach, Intestines, spleen, 
pancreas, gallbladder, and liver. It finally emp- 
ties into the inferior vena cava. 

THE LYMPH AND THE LYMPH- 
VASCULAR SYSTEM 

Lymph 
Lymph is a clear fluid, rich in white blood cells, 

and is actually blood plasma which has filtered 

through the walls of capillaries. 

It is circulated through the lymph vessels and 

in all the tissue space.- of the body. It carries 
nourishment and oxygen to the tis-ues and waste 

products from them. The tissues and organs of 

the body are bathed in lymph, so it also act- a- a 
lubricant in aiding movement. After a meal, 
lymph coming from the small intestine has a milky 
appearance because of the presence of fat. This 
milky lymph is called chyle. 

Lymph-Vascular System 

Lymph vessels and lymph glands form a net- 
work throughout the body. Similar to the veins, 
they collect lymph and begin its (low from the 
tissues toward the heart, eventually emptying 
into the thoracic duct and the right lymphatic 
duct. These ducts end by emptying into the left 
and right Subclavian vein- respectively. 

Lymph Vessels 

Lymph vessels are located in every part of the 
body that has blood vessels, except the brain, spinal 
cord, eyeball, and internal ear. Like veins, many 
of the lymph vessels contain valves which prevent 
backflow of lymph, hut unlike veins, they com- 
municate directly or indirectly with the great 
serous cavities of the body Mich as the pleural and 
peritoneal. Along the course of lymph vessels 
are -paced lymph glands of various si/ 

The lymphatic capillaries drain lymph from the 
tis-ues of the deep -tinctures and al-o from the 
skin and superficial tissues. They unite to form 
larger vessels. With increased size, the walls be- 
come stronger, until finally they are composed of 
three layer.-, like blood vessels. 



Lymph Glands 

Lymph glands are -mall Lean shaped !•■ 

found in groups of two to fifteen along the i ourse 
of lymph vessels. Sometimes just beneath the 

-kin they appear alone, (iland-. made of 

lymphoid tissue, vary in Bin and act a- filters to 

remove bacteria ami particle- from the lymph 

stream. Lymph glands al-o manufacture the 
whit*' blood cells called lymphocyte 

THE RESPIRATORY SYSTEM 

Respiration 

Respiration, or breathing, is taking air into the 
lungs to obtain oxygen in exchange] for carbon 

dioxide, which is exhaled. 

Respiratory Organs 

In man the respiratory organs are the nose, the 

mouth, the pharynx, the larynx, the trachea, the 
bronchi, ami the lungs. Accessory Organs that 
make breathing possible are the thorax, the i 

and the diaphragm. See figure 26. 

Air enters the nose and nasal chamber-, where 
it 1S filtered by little hair- called cilia. The-e take 
out dust particles that would irritate the 111] . 
T1h> chambers of the nose al-o warm and moisten 

the inspired air. 

The air then passes through the bark part of 
the mouth, where it i- moistened even mi 

The pharynx i- the passageway between the 
nasal chambers, the mouth, ami the larynx. 

The larynx, or voice box, i- just below the 
pharynx, and help- to form your "Adam".- apple." 
It is pulled upward against the base of the tongue 
and closed, when you -wallow, to keep food from 

entering the lungs. All air must pa-- through the 

larynx to the lungs, and air passing from the 
lungs to the larynx make- Bound, which we call 
speech or singing. 

The trachea, or windpipe, i- a tube formed of 
ribbed cartilage with L5 or •_'" C-shaped rii j 
It is lined with cilia and mucous glands to filter 
out dust ami dirt. 

Bronchi are branches from the trachea which 
Carry the air to the -mailer element- of the lui _-. 
the bronchioles and the alveoli, or air - 

The lungs are like two large sacs which an 
divided into lobes, ea. attaining thousands 



30 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



thqroid 
cartilage 



pleura 
covering 




bronchial 
tubes 

bronchiole 



inferior 

'loba 



RIGHT LEFT 

Figure 26. — The Lungs and Air Passage. 

of tiny alveoli with blood capillaries in their lining 
membrane. The air entering the lungs here comes 
directly in contact with the permeable membrane 
of the air sac, so oxygen filters through the mem- 
brane into the blood stream. 

Each lung is encased in a serous sac called the 
pleura, which is smooth and has a small amount of 
fluid in it to prevent friction from the rubbing of 
the lungs against the chest wall. 




Openinq of 
alveolar sacs 
into atrium 

Atrium (darK area) 
Alveoli 



Bronchiole 



Figure 27. — Minute Structure of the Lung. 



The mediastinum divides the chest into two 
separate cavities. The heart lies in this space. 

Process of Respiration 

Respiration includes not only the exchange of 
oxygen and carbon dioxide in the lungs, but also 
the reverse exchange which takes place between 
the capillaries and the tissues of the body. 

The rhythmical movements of breathing are 
controlled by the respiratory center in the brain. 
Nerves from the brain pass down through the 
neck to the chest wall and the diaphragm. The 
nerve to the diaphragm is called the phrenic, the 
nerve to the larynx is the vagus, and those to the 
muscles of the thorax, the intercostals. 

The respiratory center is stimulated by chemical 
changes in the blood, especially if they are acid. 
If too much carbon dioxide accumulates in the 
blood, the respiratory center tells the lungs to 
breathe faster to get rid of the carbon dioxide. 

Other stimulations of the body can cause in- 
creased breathing; for example, the splashing of 
cold water on the face or the chest will stimulate 
breathing; a sudden splash into cold water will 
cause a deep gasping inspiration. Emotional 
disturbances of the brain also can alter respiration, 
causing shallow breathing, sighing, laughing, or 
crying. 

The muscles of respiration normally act auto- 
matically. The respiratory cycle consists of in- 
spiration — breathing air into the lungs; expira- 
tion — breathing air out of the lungs; and rest — 
an interval between breaths. 

Normal respiration is 14 to 18 cycles per minute. 

In the act of inspiration, the diaphragm con- 
tracts, the ribs are elevated, and negative pressure 
is produced in the chest. This draws air into the 
lungs to equalize the pressure. In expiration, the 
diaphragm relaxes and the elasticity of the lungs, 
together with the weight and the elasticity of the 
chest walls, causes the chest to return to its orig- 
inal size, thus expelling the air from the lungs. 

The lungs when filled to their full capacity hold 
about 4,500 cc. of air, but only 500 cc. of air is 
breathed out at a normal quiet expiration. This 
air that is changed with each respiration is 
called tidal air. The amount of air breathed out 
or in may be increased by forceful expiration and 
inspiration. The amount of air left in the lungs 



ANATOMY AND PHYSIOLOGY 



31 



after forceful expiration is about 1,000 CO., and IS 
known as residual air. Under normal conditions 
the reserve supply <>t" air in the Lungs is :il >« >ut 2,600 
cc. 

Certain sound- are produced by i >m — :ii^*- of air 
into and out of the lungs. These sounds ma] \ ai \ 
in disease of t he lung. Doctors depend upon these 
sounds of the lungs during respiration todiagi 
pneumonia, bronchiectasis, tuberculosis, and other 
lung diseases. 

Types of Breathing 

Eupnea Ordinary quiet respiration where 

no effort \a expended. 

Dyspnea Labored <>r dilBcnlt breathing, 

Hyperpnea Applies to the initial stage <•( dysp 

nea when the respiratloD rate is 
simply being Increased 

Apnea a condition in which there la i 

temporary cessation <>f breathing. 

Cbeyne-Stokes . The respirations Inci ease with force 

and frequency op to a oertain 
point, ami then decrease until 
they cease altogether. There is 
a short period of apnea : then ill" 
respirations begin again, and the 
cycle is repeated. 

Edematous respira- a moist, rattling sound, sometimes 

timi. referred in as the "death rattle" 

ii i- caused by tin- Infiltration 

of fluid from the blood into air 

cells of the lungs. 

Asphyxia The condition produced by oxygen 

starvation, n la caused bj pro- 
longed Interference with aeration 
cd" blood. 

DIGESTIVE SYSTEM 

The digestive system is the alimentary tract. 
which begins at die lip- and ends at the anus, ami 
t he accessory organs of digestion t salivary glands, 
liver, pancreas, gallbladder). The digestive sys- 
tem carries food mi that digestion and absorption 
can occur, and it eliminates waste material. The 
secretions of the accessory organs assist in pre- 
paring the food for its absorption and use by the 
t issues of the body. 

Digestion is both mechanical and chemical. 
The food is mechanically chewed, .swallowed, 
churned by peristalsis, and evacuated when the 
bowels move. The chemical digestion consists of 
breaking down the various foods, by enzymes, into 
solutions and simple compounds. Carbohydrates 



Sublingual §land 
Submaxillary, qland 



Liver 
Hepatic duct 

Gall bladder 
Cqstic duct 
Duodenum 
Common Bile duct 

Hepatic flexure 



Cecum 

Veriform 
Appendix 




Parotid qlaod 
Pharqnx 
Esophagus 



Stomach 
Pqlorus 

Splenic flexure 
Jejunum 



Sigmoid flexure 

Roctom 
Anus 

Figure 28. — The Oigettive Syitem. 



(starches and augars) must he broken down into 
simple sugar (glucose) ; fat- an- changed into 
l'att\ acid-: protein- into amino acids (tabli 1 

Structure of the Digestive System 
The alimentary canal i- about 28 feet long 

i- divided a- follow 



Mn'iili , :i\ Itj : 
Teeth 
Tongue 

Pharj n \ 

Esophi 

Stomach 

Smalt in !• 

Duodenum 

Jejunum 

ileum 



■ Ml 

I 'i|i> II 

Tr.i olon 

I od 

• ■II 
Eta r inn 

Ann-* 



The accessory organs that aid the pr< 
digestion at • 



Pan< I 

Liver 



Gallbladder 
Intestinal gla 



The Mouth 

In the mouth the teeth break up the food mto 

.-mall particles before it t- swallowed. Here the 
salivary glands secrete saliva to help the dip 



32 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




food- carbohydrates, 
fats, proteins 



BroKen down hare 



Absorbed into the 
— ■ bloodstream 



Carried to tissue for 
energy, repair, storage 




Figure 29. — Schema of the Digestive Process. 

of starches and sugars. About 1,500 cc. (I14 
quarts) of saliva is secreted daily. This moistens 
the food, makes it easier to chew, and lubricates 
the food mass to aid in swallowing. The two 
enzymes which help digest starches and sugars 
are ptyalin and maltase; they act upon starches 
and break them down into sugars called maltose 
and dextrose. 

The tongue is a muscular organ attached at the 
back of the mouth to the lower jaw. It is con- 
cerned in taste, speech, mastication, and swal- 
lowing. 

Pharynx 

The pharynx is the connection between the nose 
and mouth and the esophagus. It is a musculo- 
membranous tube, placed behind the nasal cavities, 
mouth, and larynx. Corresponding portions of 
the pharynx are respectively named nasopharynx, 
oropharynx, and laryngeal pharynx. The phar- 
ynx serves as a passageway both for air and for 
liquids and food. 

Esophagus 

This is a muscular tube 10 inches long extending 
from the pharynx to the stomach. It passes 
through the chest and by means of waves of 



muscular contraction called peristalsis it pushes 
the food along to the stomach. When peristalsis 
is reversed, vomiting occurs. This may be the re- 
sult of overloading the stomach, disease in the in- 
testinal tract, abnormalities of the brain, or a 
toxic reaction to certain drugs. 

Stomach 

The stomach is a large muscular bag which is 
located in the upper abdomen in connection with 
the esophagus at its upper end and the first por- 
tion of the small intestine, the duodenum, at its 
lower end. There are small muscular rings at 
each end of the stomach; the one at the upper 
end is called the cardiac sphincter, and that at the 
lower end is called the pyloric sphincter. These 
tend to close off the stomach and prevent food 
from escaping in either direction while digestion 
is taking place. 

The stomach is a storehouse for food and re- 
leases food in liquid form in small amounts when 
the rest of the digestive system can take care of it. 

The stomach helps in the chemical breakdown 
of food materials. Small glands in the wall of 
the stomach secrete gastric juice. This contains 
two enzymes, pepsin and rennin, which act on pro- 
tein, and a third enzyme, gastric lipase, which 
splits fats. Gastric juice also contains hydro- 
chloric acid which helps the action of pepsin, tends 
to kill any bacteria that enter the stomach, and 
regulates the opening and closing of the pyloric 
sphincter. When food leaves the stomach it is in 
semiliquid form called chyme. At this point it is 
about half digested; the complex starches are 
partly split into simple sugars, and the proteins 
are broken down into simpler forms, peptones. 

Small Intestine 

The small intestine is a muscular tube about 22 
feet long and is attached to the spinal column 
and abdominal cavity by means of a thin band 
of tissue called the mesentery. In this band of 
tissue are located the blood vessels. The mesentery 
is gathered together like a fan, and this gathering 
arrangement permits folding and coiling of the 
intestines so that this long organ can be packed 
into a small space. The small intestine is divided 
into three long continuous parts: duodenum, je- 
junum, and ileum. It receives digestive juices 



ANATOMY AND PHYSIOLOGY 



33 



from three accessory organs of digestion: the 
pancreas, liver, and gallbladder. 

Duodenum. — The duodenum is a tube about 10 
inches long and forms a C shaped curve ju>t !»■ 

low the liver, around the head of the patur, 

The duodenum itself is lined with small glands 

which secrete intestinal juice containing the en- 
zyme, invertase, to convert sugars into their Am- 
plest form. They also secrete erepsin, which a 
on the peptones (split protein- 1 to change them 
into amino acids. The pancreas, liver, and gall- 
bladder have ducts \\ hich open into the duodenum. 

Jejunum. — This i> the middle part of the small 
intestine, aboul "'•_. feet long, and its enzymes con- 
tinue the digest ive process. 

Ileum. — This is the last and longest part of the 
small intestine; it ends at the large intestine, or 

colon. Most of the absorption of the food take- 
place in the ileum, where lin<_ r erlike projections 
from the muscle wall, called villi, provide a large 
sin face for absorption. The villi contain central 
lymph channels and a network of blood capil- 
laries. After the food has heen digested it i- ab- 
sorbed into the capillaries and lymph channels 
and thence carried to all parts of the body by the 
blood and lymph. 

Pancreas. — The pancreas is a long, pistol- 
shaped gland lyin<r behind the stomach. It 
empties into the duodenum and has digestive 
juices that act on all types of food. It contains 
a special group of cells, the Islands of Langer- 
hans, which secrete the hormone, insulin, needed 

Table I.— DIGESTIVE JUICES AND THEIR 
ACTION 



Digestive 

juice 



Source 



Acts upon— 



To produce— 



Ptyalin Sail vary stand 

Maltose do 



ii Lininc of the 

stomach. 

Kennin do 

(ia-tric li- do 

pase. 

1I\ drochloric - -do 

acid. 

Amylase Pancreas 

Trypsin do 



Rrepsin do — 

Lipase do 

Nile Liver 



Starch Complex sugar (maltose). 

Complei sue- Simple sugar (gltuo 
• 

Protein Split proteins i proteose 

and peptone). 
Milk- Consul ite milk. 

til. fat particles. 



Keep stomach 
content acM 

Starch 

Split proteins 

i|ir> I 

and pep- 
tone). 
Peptids 





Invertase Lining of the 

duodenum. 

Erepsin do 



Compl. 

ar 

and ; 
Peptids 



To facilitate the action of 

other |i 
ComjuVx sugar mil 

ind polypeptide. 



itc amino acids 
Ids and glycerin. 
A solution of fat in watery 

fluid of Intestine. 
Simple sugars if- 
galactose, and clucose). 

Separate amino ac 



for the use of sugar by the body tissui 
of insulin causes diabetes. Insulin enters the 
blood directlj and does not go l>\ waj of the in- 
testina] tract, a- do the other pancreatic enzj 



livar 



qa\l bladder 



cqsttc durf 
Portal vom 
daodarxiro 



< ^ 



Lrortol vain 
(splenic) 




dasccodiog 
— colon 



inferior 
Mesenteric 
veto 



Small intestine u / 

Figure 30. — The Portol Syitem. 

Liver. — The liver i- the largest gland in the 
body. It is located in the upper abdomen on the 
right side, ju>i under the diaphragm and above the 
duodenum and the lower end "f the stomach. 

One function of the liver i- to secrete bile 

needed to digest fats in the intestines. Bile does 
not contain a fat-splitting enzyme l>ut does I 

up the fat particle- 80 that lipase and -teap-n 

act more rapidly. Besides secret in^ bile, the liver 

has other functions : 

l. It is a storehouse for Bugar (glycogen). 

•_'. It play- a part in destroying bacteria and 
wornout red blood cell-. It take- the iron from 
Old Cells and -tore- it for u-e in making new hlood. 

3. It detoxifies chemicals ;l nd poi-ons. 

1. It manufacture- part of the protein- of hlood 

plasma, 

5. It a— ist- in making antibodies for defense 
against disease. 

6. It has an important role in fat metabolism, 

and plays a part in metabolism Of vitamin A and 
and Storage of vitamin B. 

These are only some of the known functioi 
the liver and there arc probably still othei 
to be discovered. 

(■allhladder. — The gallbladder is a dark g 



34 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



sac, shaped like a blackjack and located in a hol- 
low on the under side of the liver. Its duct, the 
cystic duct, joins the hepatic duct to form the 
common bile duct which enters the duodenum. 
The main function of the gallbladder is the stor- 
age and concentration of bile when not needed for 
digestion. 

Large Intestine 

The large intestine is about 5 feet long and is 
divided into the cecum, the ascending colon, the 
transverse colon, the descending colon, the sigmoid 
colon, and the rectum, which opens through the 
anus. In the large intestine, unabsorbed food ma- 
terial is stored. Here water is reabsorbed while 
the food is being pushed along, finally to be elim- 
inated from the body in the bowel movements. 

The unabsorbed food that enters the cecum, 
a blind sac located at the lower right side of the 
abdomen, eventually travels through the ascend- 
ing, transverse, descending, and sigmoid colon to 
reach the rectum. As the unabsorbed food mass 
moves through the colon, liquid is absorbed. Most 
of the water absorption by the body takes place 
in the colon. 

The appendix is a long, narrow tube with one 
blind end, the other end being attached to the 
cecum near the ileocecal junction. It has no known 
function, but frequently becomes infected and in- 
flamed. This is known as appendicitis. 

The Rectum and Anus 

The rectum is about 5 inches long and follows 
the curve of the sacrum and coccyx until it bends 
back into the short anal canal. The anus is the 
external opening at the lower end of the digestive 
system. It is kept closed, except during bowel 
movements, by a strong sphincter muscle. The 
function of the rectum and anus is wholly elimi- 
nation. 

Time Required for Digestion 

Shortly after a meal reaches the stomach, it 
begins to pass through the pylorus, and after 
the first hour the stomach is half empty. At the 
end of the sixth hour none of the meal is present 
in the stomach. The meal then goes through the 
small intestine and the first part of it reaches the 



cecum in from 20 minutes to 2 hours. At the end 
of the sixth hour most of it should have passed 
into the colon; in 12 hours all should be in the 
colon. Twenty-four hours from the time the food 
is eaten, the meal should reach the rectum; how- 
ever, part of the residue may be defecated at one 
time and the rest at another. 

Food Absorption 

There is very little absorption in the stomach. 
Alcohol is absorbed directly through the stomach 
wall, accounting for the fact that it doesn't take 
long to become intoxicated if you drink on an 
empty stomach. Most food absorption takes place 
in the small intestine. The liquid products of di- 
gestion pass through the mucous lining of the in- 
testines to either the lymphatics or the tributaries 
of the portal circulation which leads to the liver. 
The colon absorbs only water and the concentrated 
residue is eliminated as feces. 

Defecation 

The passage of feces, or a bowel movement, is 
called defecation. It is begun by contraction of 
abdominal and pelvic muscles. At the same time, 
the sphincters of the rectum relax and there is a 
peristaltic wave of the sigmoid colon and rectum. 
The feces are then expelled as the result of these 
coordinated muscle actions. 

Fecal material is made up of undigested food 
residue, secretions from the digestive glands, bile, 
mucus, and millions of bacteria. Mucus is derived 
from the many glands of the colon, which pour out 
their secretion to lubricate the mass as it moves 
through the colon and rectum. Bacteria are es- 
pecially numerous in the large intestine. They act 
on food, causing putrefaction of proteins and fer- 
mentation of carbohydrates. This tends to break 
up the food mass into a softer stool. 

Abdominal Cavity 

The stomach and intestines are enclosed in the 
space between the diaphragm and the pelvis, called 
the abdominal cavity. This cavity is lined with 
a serous membrane, the peritoneum. The perito- 
neum covers the intestines and organs and by se- 
creting a serous fluid prevents friction between 
the adjacent organs. Layers of peritoneum that 
extend from the body wall to an organ and sus- 



ANATOMY AND PHYSIOLOGY 



35 



pend it are called the mesentery. The mesentery 
carries blood vessels to the different organs. Folds 
of peritoneum lie in the front part of the abdo 
men connecting the stomach, Liver, and parte of 

tlif intestines. These are '-ailed the omentum. 
The upper part is called the lesser omentum : the 

lower part, which hangs below the stomach and 
over the intestine like an apron. i< called the 
greater omentum. This contains fat throughout. 

ENDOCRINE SYSTEM 

The endocrine system is made up of the glands 
of internal secret ion, called ductless glands because 
they have no ducts to carry away their secretions. 
The secretion of an endocrine gland IS called a 
hormone (meaning, I excite). The hormone- are 
very small in quantity, only a trace being neces- 
sary to produce an effect. The\ reach the effector 
organ through the blood stream. Some of them 
influence the act ivity of t he body a- a whole. .Most 
hormones can he obtained by extraction from the 
gland of an animal. Some can he prepared syn- 
thetically. These isolated hormone- may he ad- 
ministered to patients who are ill of have a de- 
ficiency of them. The hormone-producing glands 
are: t he thyroid, parathyroids, adrenals, pit uitary. 
gonads (sex glands), pancreas, intestinal glands, 
pineal body, ami thymus ( Gg. •">!). 



PINEAL BODY 

HYPOPHYSIS 
PARATHYROIDS 



THYROID 
THYMUS 




■6 \ 



i i 



\ 

I 

} \ 



ADRENAL 



-^ G> 



I 



PANCREAS 



OVARY " 
C female) 



-o o 



\t 4- 



-TESTIS 
(male) 



Figure 31. — The Endocrine Glands. 



Spleen 

The Bpleen, although not physiological] 
gland of internal secretion, has no ducta and is 
therefore anatomically a ductless gland. Located 

in the upper left pan of the abdo n beneath the 

diaphragm, it is enclosed in a capsule of connective 
and muscular tissue. It i- roughly circular in out- 
line and in the average adult weighs about 7 

ounce-. Il- chief fund ions arc : 

l. Formation of lymphocyte- and monocytes. 
•j. Phagocytosis of bacteria, inert particles, 

white I. loud cells, and probably platelet-. 

8. Destruction of old red blood cell- : storag 
iron and blood. 
1 nder stress of excitement, during exercise, or 

after injection of adrenalin, the Bpleen contracts, 
forcing blood into the circulation. In this sense 
the spleen is a reservoir of blood cell- for emer- 
gency use. 

The spleen is thought to produce a coagulating 
substance, as well as an inhibitar of platelet 
formation and certain immune substano 

Even though the spleen has many function-, it- 
removal causes no permanent damage. There i- 
no evidence that the removal of the spleen rendi 
man less resistant to infection. 

The spleen is fairly easily ruptured, due to its 
Boft, spongy consistency . Hemorrhage results. A 
hemorrhage may be -low and delayed. Bleeding 
has been known to occur a- long a- l' years after 

an injury. 

Thyroid Gland 

The thyroid gland sit- like a butterfly in the 
front part of the neck below the larynx. It 
Consists of two loin-, one on each side, connected 
ill the middle by a -trip of tissue called the i-th- 
inus. The hormone secreted by the thyroid i- 
thyroxin and stimulates the rate of metabolism of 
the body. Excessive secretion of thyroxin ra 

the metabolic rate and cau-e- a condition known 

a- hyperthyroidism. Patients with hyperthy- 
roidism have a fa-t pulse rate, di/./.ine— . in- 
crea.-e in the ha-al metabolism, pi'ofu-e Bweating, 
and a tremendous appetite yet a loss of weight. 
The eyeballs may protrude, and enlargement of 
the thyroid maj at first he felt and later observed 
in the lower neck. 



36 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Hypothyroidism is caused by an insufficient se- 
cretion of thyroxin. It is the opposite of hyper- 
thyroidism. The patient has a decrease in basal 
metabolism, sweating is almost absent, and he may 
gain weight easily and feel continually tired. 
The heart may be slow. There may be an en- 
largement of the gland, called a goiter. 

To prevent goiter one should eat food which con- 
tains iodine : vegetables, iodized salt, and sea food. 

Parathyroid Glands 

Parathyroid glands are small round bodies, 
usually four, located just behind the thyroid gland. 
Their hormone regulates the calcium and phos- 
phorus content of the blood. The amount of cal- 
cium is important in certain tissue activities, such 
as blood formation, coagulation of blood, mainte- 
nance of normal muscular excitability, and milk 
production of pregnant mothers. Removal of the 
parathyroid glands results in a low calcium level 
in the blood, and death preceded by tight contrac- 
tions of the muscles and convulsions. 

Adrenal Glands 

The adrenal glands are sometimes referred to 
as the suprarenal glands, since they sit like small 
cocked hats on the top of each kidney. They con- 
sist of an inner portion called the medulla, which 
secrets epinephrine (adrenalin), and an outer por- 
tion called the cortex, which secretes a number of 
hormones that have differing functions. 

Adrenalin, one of the body's most important 
hormones, is secreted into the blood stream and 
by stimulating the autonomic nervous system 
causes an increase in the heartbeat, blood pres- 
sure, blood sugar, and rate of blood clotting. 
In states of emotional excitement and increased 
activity, it makes possible the mobilization of the 
reserves of the body. 

Pituitary Gland 

The pituitary is a small pea-sized gland located 
at the base of the brain and has been referred to 
as the orchestra leader of the endocrines because 
of the fact that it has control over all the other 
endocrine glands in the body. It is divided into 
two lobes, an anterior and a posterior. The 
anterior lobe plays the master role and many dif- 
ferent functions are attributed to it : 

1. Its growth hormone influences skeletal 



growth. Disease of the gland may cause gia - r 
ism, dwarfism, or acromegaly (a disease in whlc'h 
the hands, feet, and lower jaw enlarge) . 

2. The thyrotropic hormone influences the 
thyroid gland, stimulating the thyroid to secrete 
its hormone. 

3. The gonadotropic hormone influences the 
gonads (ovaries or testicles) and is essential for 
normal development and functioning of the repro- 
ductive system. 

4. The adrenotropic hormone is related to the 
growth of the adrenal glands, and the absence 
of the pituitary leads to the rapid atrophy of 
the adrenal glands. A newly isolated hormone, 
ACTH, is in this category, since it stimulates the 
adrenal cortex. ACTH stands for adrenocortico- 
tropic hormone. 

5. The lactogenic hormone is responsible for the 
development of the breast during pregnancy, and 
for the production of milk. 

6. The parathyroids and pancreas are also af- 
fected by the pituitary. 

Pituitrin is a secretion of the posterior lobe of 
the pituitary. It affects smooth muscle, causing 
it to contract, and has an effect on the kidney 
to prevent excessive formation of urine. 

Pitocin is another isolated hormone of the pos- 
terior pituitary which is given to cause contrac- 
tion of the uterus after a baby has been delivered. 

Gonads 

The gonads, the ovaries in the female and the 
testes in the male, produce hormones that are 
important for the functioning of the reproductive 
system. These glands become active at puberty 
and are responsible for the appearance of second- 
ary sex characteristics. These include pubic and 
axillary hair, the beard in the male, the develop- 
ment of the breasts in the female, and the chang- 
ing of the voice. 

Pancreas 

The pancreas contains clusters of specialized 
cells called the Islands of Langerhans. These cells 
secrete insulin into the blood stream. Insulin is 
essential for the use and storage of carbohydrates 
by the body. When the islet cells are destroyed or 
stop functioning, the sugar absorbed from the in- 
testine remains in the blood and is thrown off by 
the kidneys into the urine. It is not used and it 



ANATOMY AND PHYSIOLOGY 



37 



is not stored. This condition is called diabetes 
mellitus, or sugar diabetes. I osulin is given bypo- 
dermically to patients having this disease, as part 
of their treatment. 

Intestinal Glands 

The intestinal glands have hormones. The du- 
odenum supplies a hormone, secret in, w hich causes 

the intestinal juices to How whenever food reaches 

the intestines. The liver and spleen are also be- 
lieved to supply hormones to the blood, hut tip 
have not as yet been isolated. 

Pineal Gland 

This is a small gland located near the roof of 
the brain. It is thought to exert an influence on 
the rate of growth of the entire body and the onset 
of puberty (when the reproductive glands of the 
body become active). 

Thymus 

The thymus is an organ located in front of the 
trachea, partly in the neck and partly in the 
thorax. It is large in infancy and shrinks a- the 
individual matures. Little is known concerning 
the function of this gland. 

THE EXCRETORY SYSTEM 

Table II.— EXCRETORY ORGANS OF THE 
BODY 



Excretory organs 



Kidneys. 

Skin (sweat glands) . 

Lungs 

Intestines 



• tions 



Nitrogenous wastes, toxins, water from Ingestion, 

mineral s:iits. 
Water, mineral salts, mull amounts nf nitrogenous 

wastes, 

Carbon dioxide, water vapors, small amount of 
nitrogen. 

from digestion, some metabolic 

i lull- pigment, salts of. call linn, etc). 



Table III.— PHYSICAL CHARACTERISTICS OF 
NORMAL URINE 



Characteristics 



iption 



Amount (24 hours). 



Clearness. 

Color 



Odor 

Specific gravity, 
pii (actor 



40 to SO fluid ounces (1.200 to 1.500 cc). May vary 
more or less, depending on many factors, such as 
fluid intake, mrdirjrial substances, atmospheric 
conditions and dil 

Transparent or clear, upon standing becomes 
cloudy. 

Varies from pale yellow to a brownish hue. Color 
variations dependent on amount voided, foods 
and medicinal substances. 

Odor of ammonia which is influenced greatly by 

diseaa ' foods, and otner sabstai 

Varies from 1 (U."> to 1.025. 

Acid in reaction. 



Table IV.— CHEMICAL CHARACTERISTICS OF 
NORMAL URINE 









Composition 03 perer-nl « >' lids corapoeed of 

nitrogenous wash . organic and in- 

Normal constituent! Clili f nltn 

extent of about 3 percent alts of 

all amount - •■! ' rmati-v 
um, ammonium, 
iiid m igm 
Abnormal constituents Albumin. 

found do. oodltloos. 



The wa-te products resulting from the activities 
of the body are called excretion- ami an- dis- 
charged to the exterior by organs known u 
cretory organs, Borne of which are arranged in 
Systems. 

The Urinary System 

The kidneys are two large, bean-shaped organs 
designed to filter wa-te materials from the blood. 

They are located in the upper part of the abdomi- 
nal cavity, just outside the peritoneal .sic. one on 
each Bide of the spinal column. The upper end of 
each kidney reaches aho\e the level of the twelfth 

rih. The suprarenal gland (adrenal gland) 

like a cap on top of each kidney. The khli • 

weigh about I to t; ounces, and measure about \\'« 
by 2 by 1 ' - 2 inches. Attached to the hollow 



Cortex 



Medulla 

(renal 

pqramid) 




Renal 
papilla 



Urctcr-f?/ 



R«znal 
& column 



Figure 32. — Cross Section of the Kidney. 



211800"— 53- 



38 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



side of each kidney is the dilated upper end of a 
ureter, which is the outlet tube of the kidney and 
extends downward to the bladder, located in the 
pelvic cavity. The hollow side of each kidney, 
together with the dilated end of the ureter, forms 
the kidney pelvis. 

The essential unit in the kidney is a tiny filter- 
ing sac called the glomerulus, in the hollow center 
of which is a coiled loop of blood capillaries. This 
glomerular sac has a narrow tubular outlet. The 
first section of this tubule is surrounded by capil- 
lary blood vessels to reabsorb certain essential 
elements in the urine. The coiled tubule is con- 
tinued as a straight tubule, which finally unites 
with other similar tubules and empties into the 
kidney pelvis. 

In action, the kidney is a blood filter, the 
watery portions of the blood passing through the 
capillaries and glomerular walls. The fluid fil- 
tered out of the blood flows out of the glomerular 
sac and down the tubule. On its way special 
cells lining the tubules select from the fluid essen- 
tial substances which are still of use to the body, 
and return them to the blood stream. The com- 
bined water and wastes removed from the blood 
by the kidneys form the urine. These wastes would 
poison the body and kill it in a few days, if they 
were left in the blood stream. Urine is carried 
from the kidneys through the ureters to the 
bladder, from which it is expelled through the 
urethra. These structures do not perform any ex- 
cretory work. They simply conduct the urine on 
its way out of the body, and the bladder acts as a 
temporary storage place so that urine can be ex- 
pelled at convenient times instead of escaping in 
the form of a continuous dribble. 

In the filtration of the urine each kidney has 
about one million glomeruli to perform its job. 
There are many reserve glomeruli, so that large 
portions of the kidneys may be destroyed by dis- 
ease before the patient is seriously handicapped. 

Blood pressure is also important in the speed 
at which the blood filters through the kidneys. 
If the blood pressure drops too low, as in shock, 
kidney filtration stops. If it goes too high, 
it may injure delicate cells in the kidney and 
cause damage to the kidney substance. Kidney 
damage is one of the complications of high blood 



pressure. Injury to the cells lining the tubules 
leads to a loss of substances which the body ought 
to retain, but does not necessarily cause high blood 
pressure. In this case the body may lose albumin 
which should be kept in the blood stream. 

The blood that passes through the kidneys comes 
via the renal arteries from the aorta. They divide 
repeatedly into smaller and smaller branches until 
they are finally tiny, thin-walled capillaries found 
in the glomeruli. The venous return is by the 
renal veins. 



Branch to Renal Vein 




Branch from 
Renal arters 



Bowmen's capsule 





Proximal convoluted 5? j rjj"ct*i\i 

tubule $ PjcSutk I 

tubule '-i;i& 

un- 
collecting 

tubule 
Henles loop^ 



Figure 33. — Functional Unit of the Kidney. 

How the Kidneys Work 

The kidneys are effective blood purifiers. They 
filter waste materials from the blood and excrete 
them in a watery solution known as urine. They 
also play an important role in keeping the reaction 
of the blood normal, making sure that it does not 
get too acid or too alkaline. The normal blood 
reaction is slightly alkaline. They do this by ex- 
creting enough substances from the blood to main- 
tain this alkalinity. For example, if the blood 
becomes too acid they will excrete acid in the 
form of salts ; on the other hand, if too alkaline 
they will excrete alkaline salts. 

The kidneys also remove excess sugar, when 
present in the blood, but the main job of the kid- 



ANATOMY AND PHYSIOLOGY 



39 



neys is to excrete nitrogenous waste products 
which are produced in the breakdown of pro- 
teins. 

Besides filtration, the second important func- 
tion of the kidneys is reabsorption of water, -alt-. 
SUgar, and protein element- of the blood. Tin- 
selective reabsorption keep- the blood at an acid- 
base balance and also a constant concentration of 
water, salts, and proteins. Thisdelicate balance i> 

ential for normal life. Controlled reabsorption 

accounts for the amount of urine which i- finally 
passed from the kidney-, for the glomerulus 

Biters gallons of hlood each .lay. It i- estimated 
that 10,000 quarts of hlood pass through the kid- 
neys in 24 hour- and ahout 80 gallons of mine i- 
formed, but all of the water from this urine i- 

reabsorbed in the kidney tubules except that con- 
taining the concentrated wa-te product-. The 

amount of urine excreted by a normal adult i> 

from 1,000 to 1,500 CC. per day. However, a per- 
son can net by if he secrete- even a- little as 500 cc. 
per day. 

The amount of urine varies greatly with tem- 
perature, water intake, and -tates of health or 
disease, but no matter how much water you drink 
the hlood will always remain at a constant concen- 
tration, and the exec-- water will he excreted hy 
the kidneys. A large water intake doe- not put a 
strain on the kidneys as some may think. Rather, 
it eases the load of concentration placed on the 
kidney. 

In blood plasma there is normally present ahout 
0.03 percent of urea, while ill the urine there 
is normally (>7 times as much, or ahout -1 percent 
This great increase is Largely due to concentrating 
the urea contained in a very large amount of kid- 
ney filtrate in a relatively -mall amount of urine. 

Besides removing waste products normally 
found in the body, the kidneys can remove toxic 
substances such as barbituric acid, mercury, alco- 
hol, and other medicines. 

It is plain to see how e— ential the kidneys are 
to the well-being of the body. 

One of the familiar conditions- which causes the 
loss of albumin from the body is damage to the 
glomeruli. This is sometimes called glomeru- 
lonephritis. 

Uremia is when the kidneys fail to remove the 
waste products from the hlood stream and they 



accumulate in high concentration in tin- blood. 
This condition i- serious and sometimes fatal 
The ureters arc two membranous tubes ibout 

1.". to Is inches Ion- that extend from the kid 
pcl\ i- down the hack of the ahdomilial cavity and 
empty into the urinary Madder. They arc ahout 
the -l/.e of a gOOSC miill. 

The urin;ir> bladder is a musculomembranous 

BaC locate. 1 ill the pelvis an. I -ci\.- a- a !<•-.! \oii 
for urine. It empties through the urethra. 

The urethra is a membranous tube from the 
bladder through the penis, ending in a meatus or 
opening. It serves to convey the urine ami. in 
the malr. the secretions «.f the genital glands to 
the exterior. In the male it i- ahout eight inches 
long and divided into three parts, the prostatic, 
the membranous, and the penile portion-. The 

prostatic urethra, about l inch in length, is sur- 
rounded by the prostate gland. It contain- the 
orifices of the prostatic ami the ejaculatorj ducts. 
In this portion the urethra i- the largest. The 
membranous urethra i- about one-half inch in 
length. The penile urethra is the longest and lies 
along the base of the penis, extending to its external 

opening, the urinary meatus. 

Micturition i- the act of voiding urine. This 
is an involuntary mechanism cut rolled partly h\ 
the will. 



hair follicle 



Lpidarmis 




Gland 



papilla o 
hair 




— duct of Suiaat 
Gland 



bodq of Su/cat 
GldOd 



Figure 34. — Structure of the Skin. 



Skin 

The -kin cover- almost every vi-ihle part 
the human body. Even the hair and the nails 
are outgrowths from it. The skin ha- much 
to d<> with your personal appearance, hut the 

skin i- more than something to look at. for it 



40 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



serves the body in many important ways. It pro- 
tects the underlying structures. It is a defense 
against germs. It contains nerves that transmit 
the sensation of touch, heat, cold, and pressure. 
It helps to dispose of body wastes. It plays a 
mighty part in the regulation of body temperature. 
To better understand how the skin does its work, 
one should know how it is constructed. 

The skin is composed of two chief layers — the 
outer, the epidermis, and the inner, called the 
cutis vera or true skin. The outer cells of the 
epidermis are flat and lifeless, looking like dry, 
clear, overlapping scales. This scaly layer if un- 
broken is able to block the passage of almost every 
known variety of disease germs. The deeper cells 
are allied and multiply rapidly. Among them 
are special cells containing pigment, the color and 
quantity of which are the chief factors in deter- 
mining your complexion. The newly formed cells 
push the older cells outward. The nearer they 
approach the surface, the drier or more scalelike 
they become and the less life there is in them. It 
is because of this constant activity of the deeper 
cells of the epidermis that any injury to the skin, 
if it goes no deeper than its outer layer, is re- 
paired in a few days, leaving no scar. 

The hair and nails are modified epidermis. 
Their main protective functions are self-evident 
and need no explanation, but the way in which 
the eyebrows and eyelashes shade the eyes to keep 
out dust and other harmful objects is a special 
evidence of wise planning in the construction of 
your body. 

The sweat glands are coiled tubular glands 
which lie imbedded in the derma and are sur- 
rounded by a small tuft of capillaries. These 
glands, located partly in the subcutaneous tissue, 
open by ducts to the surface of the skin. The 
sweat glands serve as excretory organs, excreting 
the sweat, or perspiration. 

The sebaceous glands are sacular glands, the 
ducts opening about the hair shaft. These glands 
secrete an oily substance, sebum, which keeps the 
skin soft and pliable. 

The true skin (cutis vera) , besides having nerve 
endings for touch, heat, cold, and pain, have motor 
nerves to the blood vessels and secretory nerve 
fibers to the glands. 

Perspiration, or sweat, given off by the sweat 
glands is a clear, colorless liquid with a slightly 



acid reaction. It has a salty taste and a distinc- 
tive rancid odor, or no odor at all. Perspiration 
is being secreted constantly, taking place so gradu- 
ally that it evaporates as fast as it is formed. This 
is known as insensible perspiration. Under ex- 
posure to heat, or exercise sufficient to produce 
perspiration so rapidly that evaporation does not 
take care of it, we have what is known as sensible 
perspiration. 

Normally, about one quart of this fluid is ex- 
creted daily. However, the amount varies 
with atmospheric temperature and humidity, and 
the amount of exercise taken. Sweat consists of 
water, salts, fatty acids, urea, and carbon dioxide. 

THE MALE REPRODUCTIVE SYSTEM 

The essential male organs of reproduction are 
the penis and the testes (testicles) . The testes are 
held in a sac of skin called the scrotum. The male 
or sperm cells are formed by the testes. They pass 
into coiled tubular structures called the epididy- 
mides, where they are stored. They next travel 
through long narrow tubes, the ducti deferentia, 
to short ejaculatory ducts which end in the 
urethra. 

During sexual intercourse the sperm cells, to- 
gether with fluid secreted by the prostate gland 
and the seminal vesicles, pass out through 



Ductus Deferens 
(ot) vas Deferens 



Seminal vesicles 




6LANS 

Penis 



Scrotum 

URETHRA 

Figure 35. — The Male Reproductive System. 



ANATOMY AND PHYSIOLOGY 



41 



the urethra and arc deposited within the ragina 
of the female. The sperm cells can swim about 
actively in this fluid and in the mucufi covering 
the lining of the female genital organs. Even 
though the sperm cells are not deposited near the 

ovum at first, it may not lie long until one of them 

finds it. They often travel throughout the length 

of the uterus and fertilize the OVttm while it is 
still in the oviduct. 

The testes, prostate, and seminal resides arc con- 
tinually at work. The combination of sperm cells 
and fluid which they produce is called -emen. 1 f a 
man does not have sexual intercourse, semen may 
be discharged through his urethra every few «lays. 

The discharges usually occur at uighl and are 

called nocturnal emission-. These have heen 

talked about by quacks to frighten men into think- 
ing that they have some serious disease and need 
Bome medicine to cure it. The fact is that Mich 
nocturnal emissions arc no sign of disease: they 
do no harm, nor do they weaken a man any more 
than menstruation does a woman. 

Sometimes what appears to he semen will drip 
from the penis when a man is straining to move 
his bowels. Quacks also frighten men about this 
by telling them that they are losing their sexual 
power. The truth is that this apparent semen 
is usually nothing hut prostatic fluid squeezed out 
of the gland by pressure within the pelvis due 
to straining at the stool. In some men with con- 
stipation, the pressure of the fecal mass produces 
the same effect. 

Testes 

The testes are oval glands suspended in a 
sac of skin, the scrotum, by the spermatic cord. 
The function of the testes is to produce sperma- 
tozoa (sperm cells) and the male sex hormone. 
This male hormone i- responsible for the develop- 
ment at puberty of the secondary male .-ex char- 
acterist ics such a- growth of beard, deep voice, and 
masculine body build. 

The epididymis is a division of the testis just 
outside the gland propel- that stores the -perina- 
tozoa for long periods of time and eventually trans- 
mits them to the ductus deferens. 



Ductus Deferens (Vas Deferens) 

The ductus deferens is a tinj tube thai ex- 
tern l> from the epididymis up through the inguinal 
canal toward the bladder. It carries the sperma- 
tozoa to the ejaculatory duct, through which they 

paSS to the urethra. 

Seminal Vesicles 
The Beminal resides are two pouches that lie 

bet ween the bladder and the reel 111 ii, ami unite with 

the ductus deferens t<> form the ejaculatory duct 

The resides Secrete and -tore a fluid to Im- added 
at the time of an cja- illation to the -ecretioii of the 

test 

The Ejaculatory Duct 

The ejaculatory 'In. i is i short tube that leads 
into the prostatic nieiha. During sexual inn 
course spermatozoa from the ductus deferens and 
fluid from the Beminal resides are discharged into 

the ejaculatory duet. The eja.iilatoiv duct then 

contract- and discharges these substances into the 

urethra. 

The Prostate Gland 

This gland is made up of smooth mu-cle and 
glandular tissue that surrounds the first Bection of 
the urethra. It resembles a horse chestnut in -i/.c 
and shape. The prostate gland secretes an alkaline 

fluid to keep the sperm mobile and protect them 
from the acid secretion of the female vagina. This 
IS discharged into the urethra during intercourse, 

Cowper's Glands 

Cowper's glands (bulbo-urethral) are two pea- 
sized bodies on each -ide of the membranous 
urethra and opening into it. They secrete a fluid 

that is chiefly mucus and Berves t<> protect the 

spermatozoa. 

Urethra 

The urethra i- a canal which extend- from the 
urinary bladder to the external opening of the 
penis. It ir- the common canal for both the mine 
and semen. 

Penis 

The penis is composed of the urethra and three 

masses "t spongy tissue which become Bwollen with 



42 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



blood during erection. The enlarged end of the 
penis is called the glans penis, and at birth is en- 
closed in a fold of skin called the prepuce or 
foreskin. The prepuce is often operatively re- 
moved, by circumcision, to prevent irritation and 
make it easier to keep the glans clean. 

Spermatic Cords 

The spermatic cords are two cords, each consist- 
ing of vas deferens, arteries, veins, lymphatic 
ducts, nerves, and connective tissue. These struc- 
tures come together in the abdominal cavity and 
pass into the scrotum through the inguinal rings. 

Scrotum 

The scrotum is a muscular sac covered by skin, 
enclosing the testes. This sac provides a cool en- 
vironment for the testes, which is essential to the 
growth and maturation of sperm cells. 

Semen 

The semen is made up of spermatozoa and secre- 
tions from the seminal vesicles, prostate, and Cow- 
per's glands. There are millions of sperm cells in 
each ejaculation, but only one is needed to fertilize 
a female ovum. 




Figure 36. — The Female Reproductive System. 



THE FEMALE REPRODUCTIVE SYSTEM 

The female reproductive system includes the ex- 
ternal genitalia, the vagina, the uterus, the fallo- 
pian (uterine) tubes, and the ovaries. 

The part of the female reproductive organs 
that can be seen at the surface of the body is 
called the vulva. The urethra, through which the 
urine is voided, opens near the front of a slit in 
the middle of the vulva. Behind the urethral 
opening is the vagina, a broad tube averaging about 
4 inches long, leading upward to the mouth of the 
uterus (womb), a pear-shaped muscular organ. 
From the upper corners of the uterus, small tubes 
extend sideways toward the ovaries. These tubes 
are called oviducts or fallopian tubes. The 
ovaries are glands about the size and shape of 
almonds. 

The essential female organs for reproduction 
are the ovaries and the uterus. The ovaries 
produce the ova, one of which normally matures 
each month. The maturing of female sex cells, 
or ova, goes on for about 30 years of a woman's 
life, beginning between the ages of 10 and 15 and 
stopping between the ages of 40 and 50. The 
uterus provides a place where a fertilized ovum 
can be protected and nourished while it is develop- 
ing into a baby. In making ready to receive and 
nourish an ovum, the lining of the uterus becomes 
swollen and soft and has much more blood in it 
than usual. If the ovum is not fertilized and the 
blood is not needed for its nourishment, the excess 
blood and part of the swollen membrane soon es- 
capes from the uterus through the vagina in the 
form of a bloody discharge. Since this discharge 
ordinarily occurs about once a month, it is called 
menstruation. 

The External Genitals 

These include the labia majora, which are two 
folds of skin extending from the mons pubis in 
front to the anus in back. Within these two folds 
of skin are two smaller folds called the labia 
minora, or minor lips. The clitoris is a small body 
composed of erectile tissue located at the point 
where the two labia minora meet; the vestibule is 
the space between the labia minora into which the 
urethral and vaginal orifices open; the hymen is a 
fold of mucous membrane which extends across the 



ANATOMY AND PHYSIOLOGY 



43 



lower pari of the vagina. The mons pubis is the 

fat pad located in front of the -_v mphv EOS pubis. 

It is composed of fatty tissue and covered wit h skin 

and haii - (in the adult ). 

The Vagina 

The vagina is the muscular canal Lined with 
mucous membrane which extend- From the cervix 

oi- neck of the uterus to i he external genitals. The 
posterior wall is about 1 inches long and the an- 
terior wall i- about ."'> inches long. Its Lining mem- 
brane is greatly folded and is continuous with 
the inner lining of the uterus. The vagina is 
Capable of Stretching widely to serve as a hi ith 
canal during the delivery of a baby. 

The Uterus 

This a hollow, pear-shaped smooth muscle or- 
gan lined with a specialized epithelium called 
endometrium. Normally it is about 3 inches long 
by 3 inches wide, at its upper widest portion. 
There are two openings at its upper corners, into 
the fallopian tubes. It has a tubelike canal in 
its lower portion, called tin- cervix, which opens 
into the vagina. 

The Fallopian Tubes 

These are two musculomembranous tubes which 
have free openings in the lower abdominal cavity 
near the ovaries and terminate by opening into 
the uterus. Their free ends are shaped like a 
funnel, surrounded by fingerlike processes de- 
signed to help the ovum, when it is released by the 
ovaries, find its way into the tube and down to 
the uterus. 

The Ovaries 

The ovaries are two almond-shaped glands sus- 
pended by Ligaments in the lower abdominal cav- 
ity, one on either ,-ide of the uterus. Their prime 
function is to produce the ova and female hor- 
mones, such as estrogens and progesterone, which 
are necessary for maintaining the menstrual cycle. 

Each ovary normally releases an ovum each 56 
days, the right and left ovary alternately dis- 
charging on ovum every 28 days. Men-t mat ion 
in most women is therefore a 28-day cycle. 



THE NERVOUS SYSTEM 

Afost body activities are largely under the con- 
trol of nerve-. Trophic nerves an- concerned 
with the growth, nourishment, and repair of ti-- 

-we. Motor nerve- control the action of muscles. 

Sensory nerve- and special .-en-e organs, such as 
the eyes and ear-, keep the bodj in touch with 
the outside world, so thai it may adjust to its own 
welfare and safety. The chief business of auto- 
nomic aerves i- to control and harmonize the work 
of the vital organs. The entire nervous system is 

made Dp of nerve cell-, their branche-. and sup- 
porting ti— ue-. Bach nerve .ell has a body and 
one or more branche-. Ganglia are groups of 

nerve cell-. Long nerve cell branche- are called 
nerve liber- or axon-. When -everal of the-e li- 
her- pun together in one cordlike bundle, vv,- 
call the white, glistening cord a nerve, or nerve 
trunk. 

NUCLEUS 



Terminal branches 




Figure 37. — Diagram of a Motor Neuron. 

What i- called the central nervous system con- 
sists of the brain, the spinal cord, and the nerve 
trunks and liber- connected with them. The brain 
is almost entirely enclosed in the skull, but it is 
closely connected with the spinal cord, which lies 
in the back bone in a tube formed by the column of 

ring-shaped vertebrae. From the brain 11 pairs 
of nerve trunk- go out to various part- of the 
head ami neck, and one pair <_'<h- down to the 
chest and the upper part of the abdominal cavity. 
From the spinal cord :'>1 pair- of nerve trui, 
out tot he neck, trunk, and limb-. 

Divisions of the Brain 

The brain ha- two main division! — the 

brum (large brain), and the cerebellum (small 



44 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Central Sensory 
3rd Ventricle 



Motor 



Intelligence -Memory 
Judgement - 7><xgd* 



Parietal 
Lobe 




Lateral 
;g%K' Ventricles 



Cerebellum 
(equilibrium) 



Taste-Smell- Hearing s& 
Temporal Lobe 

^Medulla (vital centers) 
« Spinal Cord 



Figure 38. — Functional Areas of the Brain. 

brain) . The cerebrum occupies nearly all of the 
cranial cavity. The cerebellum is situated be- 
neath the rear portion of the cerebrum. The 
cerebrum is concerned with sensation, thought, 
memory, judgment, reason, and the initiation or 
management of those motions that we say are 
"under the control of the will." 

The cerebellum is chiefly concerned with bring- 
ing balance, harmony, and coordination to the mo- 
tions initiated by the cerebrum. 

The cerebrum is divided into two hemispheres. 
The outer surface is called "gray matter" because 
the nuclei of cell bodies make it appear gray. 
Beneath this layer are connecting axones, or nerve 
fibers, which form the medulla or central portion 
of the brain. This is called "white matter." 
The cortex or surface of the brain is thrown into 
folds called convolutions, separated from each 
other by grooves or fissures. Certain areas of the 
brain are localized for certain functions. For ex- 
ample, in the frontal lobe is the motor area which 
controls body movements, speech, and writing. 
The frontal lobe is also the seat of intelligence, 
memory, and the association of ideas. 

Two smaller divisions of the brain, but vital 
to life, are the pons and medulla oblongata. The 
pons consists chiefly of a mass of white fibers con- 
necting the other three parts of the brain — the 
cerebrum, the cerebellum, and the medulla ob- 
longata. It acts as a "bridge," which its name 
signifies. 

The medulla oblongata is the lowest part of 
the brain, just above the spinal cord. In it are 



the centers for the control of heart action, breath- 
ing, circulation, and other vital processes, such as 
the control of body temperature. 

Inside the brain are small cavities which con- 
tain cerebrospinal fluid. The outer surface of the 
brain is covered with three layers of membranes 
called the meninges. When these become infected 
we have what is known as spinal meningitis or 
cerebrospinal meningitis, depending on whether 
or not the brain and spinal cord are both infected. 

Cerebrospinal fluid is formed by a plexus of 
blood vessels in the central cavities, or ventri- 
cles of the brain. It is a clear, watery solution 
similar to blood plasma. The total quantity in 
the spinal system at one time is about 75 cc. and 
the amount produced daily is about 2,000 cc. It 
is constantly being produced and reabsorbed. It 
circulates over the surface of the brain and spinal 
cord and serves as a protective cushion as well as 
a means of exchange of food and waste materials. 

Functions of the Central Nervous System 

The central nervous system is much like a great 
telegraph system. The brain is its central office. 
The spinal cord and ganglia are substations. The 
nerve trunks are cables. The nerve fibers are 
separate wires, making connections in or between 



Posterior Horn 







teaa^~ 



Grey Matter 



Dorsal Root 
Csensory) ^^ ^ , 

(motor) Anterior 
Horn 

IfflW Ef rector 

Cgland,musclt) 

Figure 39. — A Simple Reflex Arc. 



the central office and the substations, or going out 
to all parts of the body. Like the office of the tele- 
graph system, the brain may send out orders in 
response to messages it receives. It also has 
the power to send out orders without first receiving 
messages. 



ANATOMY AND PHYSIOLOGY 



45 



If you touch a hot stove and jerk your hand 
away from it before you have time to think, you 
have an example of a reflex. This action takes 
place on the spinal cord level in what you might 

term a substation, and is not relayed to the brain. 
Physicians find reflexes useful in testing the ei 
ficiency of the substations of the uervous system, 

and from them they can also learn much about 
the central office. 

Education consists of changing voluntary ac- 
tions into reflex actions. When a child is learn- 
ing to walk, every step he takes is a conscious 
effort, hut in later years he walks without thinking 
of his steps. 

The spinal cord may he thought of as an electric 
cable containing many wires (nerves) connecting 

the parts of the body to each other and to the 
brain. Sensations received by a sensory nerve are 
brought to the spinal cord and the impulse i- 

transferred either to the brain or to a motor nerve. 
In the motor nerve the impulse travels out to a 
muscle or gland and produces an action. 'The 
arrangement of these nerves — sensory, associa- 
tion, and motor — is called a simple reflex arc, 
and the action produced, a reflex action. A reflex 
act is one which is an involuntary response to a 
stimulus; you may or may not he conscious of it. 
If you are conscious of it. it is because the impulse 
was also relayed to the brain. 

Peripheral Nervous System 

The peripheral nervous system is made up of 12 
pairs of cranial nerves and 31 pairs of spinal 
nerves, stemming from the brain and spinal cord 
respectively. These nerves carry both voluntary 
and involuntary impulses. The cranial nerves are 
mostly voluntary except for a few fibers goin<r to 
the eye muscles, the salivary glands, the heart, 
the smooth muscles of the lungs, and the intestinal 
tract. The spinal nerves send fibers to all mus- 
cles of the trunk and extremities, the involuntary 
fibers going to smooth muscles and glands of the 
gastrointestinal tract, genitourinary system, and 
cardiovascular system. 

Cranial Nerves 

The cranial nerves are -ensory. motor, or mixed 
(sensory and motor). They are: 
1. The olfactory nerve (sensory) — the nerve of 

smell. Conveys the sense of smell from the mu- 



cous membrane in the upper nose to tin- olfa torj 

center in the brain. 

2. The optic nerve (sensory ) conveys the 

Ration of Bight from the retinal cell- of the eye 
to the visual area of the brain. 

:'>. Thi oculomotor nerve l motor) — controls 
muscle- that move the eychall and some of those 
in the iris of t he eye. 

I. The trochlear nerve (motor) — controls the 
muscle that turns the eychall down and to the aide. 

5. The trigeminal nerve ( motor ami sensory) — 
i- divhled into three divisions: the ophthalmic 
(to the eye), maxillary I to the upper cheek), and 
mandibular (to the jaw and lower face). 

6. The abducens nerve (motor) — control- the 
muscle that turn- the eye outward. 

7. The facial nerve (motor and sensory) — 
Controls mUSCleS Of the face. BCalp, and ear-. It 

contains autonomic motor liber- causing the sali- 
vary glands to secrete and carries taste sensation 

from the front two-thirds of the tongue to the 
brain. 

8. The acoustic nerve i -ensory) — is the nerve 
of hearing and equilibrium. 

9. The glossopharyngeal nerve (motor and 
sensory) — carries sensations from the pharynx 
and hack third of the tongue. Through the auto- 
nomic nervous system, this nerve stimulates the 

parotid (salivary) gland to secrete. 

10. The vagus nerve (motor and sensory) — i- 
composed of motor fibers I Borne of which are para- 
sympathetic) and sensor} fibers. It ha- an exten- 
sive distribution, extending down through the neck 
to the pharynx, larynx, trachea. BSOphagUS, and 

thoracic and abdominal viscera. 

II. The accessory nerve (motor) — enervates 
two muscles of the neck. 

12. The hypoglossal nerve (motor) — controls 
the muscles of the tongue. 
Spinal nerves arise from the Bpinal cord and 

pa-- out between the vertebrae. There are .".1 

pain — 8 cervical. 12 thoracic, B lumbar. .'» sacral, 

and 1 coccygeal. The lower -pinal nerve- going to 
the lower ext remit ie- extend below the level of 
the spinal cord in parallel strand- called the 
cauda equina since they re-emble a hone's tail. 

They emerge through openings in the sacrum 
to go down the thigh. Spinal nerve- contain all 
type- of -ensory and motor fibers of both the 



46 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



voluntary and autonomic nervous systems. In 
some regions of the body they interlace in a net- 
work called a plexus. The cervical plexus is lo- 
cated in the neck and the brachial plexis in the 
shoulder; lower are found the lumbar, sacral, and 
pudendal plexuses. 

Autonomic Nervous System 

The autonomic nervous system, as its name im- 
plies, functions automatically. It is the part of 
the system which controls the heart, smooth mus- 
cle, sweat and digestive glands, and some of the 
endocrine glands. Its control over these reactions 
is almost wholly involuntary ; yet the behavior 
of the autonomic system reflects somewhat the 
activity of the central nervous system, for the 
two are closely connected. The autonomic nervous 
system is divided into the sympathetic and the 
parasympathetic systems. 

Sympathetic system. — Numerous ganglia 
(nerve centers) located just outside the spinal 
cord beside the vertebra, are the basis of the sym- 
pathetic (thoracolumbar) system. These nerve 
centers connect with the thoracic and lumbar 
spinal cord and, through the spinal nerves, with 
the muscles, organs, and glands that they affect. 

The parasympathetic system. — The ganglia of 
the parasympathetic system are located in the mid- 
portion of the brain, the medulla oblongata, and 
sacral regions. For this reason it is sometimes 
called the craniosacral system. The group in the 
midbrain and medulla sends out impulses through 
cranial nerves (oculomotor, facial, glossopharyn- 
geal, vagus). The Sacral group stems from the 
second, third, and fourth sacral nerves. 

Function of the autonomic nervous system. — 
The autonomic nerves belong to a group that is 
not directly under the control of the brain, but 
that usually works in harmony with the nerves 
which are under brain control. Because one func- 
tion of the sympathetic system is to increase the 
activity of the body to enable it to meet danger or 
undergo strenuous physical activity, it has been 
called the "fight" or "flight" nervous system. 

The parasympathetic system acts in opposition 
to the sympathetic and the two opposing func- 
tions tend to keep the body in delicate balance. 



Table V.— FUNCTIONS OF THE AUTONOMIC 
NERVOUS SYSTEM 



Sympathetic 



1. Dilates pupils. 

2. Lessens tonus of ciliary muscles, so 

that the eyes are accommodated 
to see distant objects. 

3. Dilates bronchial tubes. 

4. Quickens and strengthens the action 

of the heart. 

5. Contracts blood vessels of the skin 

and viscera so that more blood 
goes to the muscles where it is 
needed for "fight or flight." 

6. Relaxes gastrointestinal tract and 

bladder. 

7. Decreases secretions of glands (ex- 

cept sweat glands which secrete 
more). 

8. Causes contraction of sphincters to 

prevent emptying of bowels or 
bladder. 



Parasympathetic 



Contracts pupils. 

Contracts ciliary muscles, so 
that the eyes are accommo- 
dated to see objects near at 
hand. 

Contracts bronchial tubes. 

Slows the action of the heart. 



5. Dilates blood vessels. 



6. Increases contractions of gas- 

trointestinal tract and muscle 
tone of the bladder. 

7. Increases secretions of glands 

(except sweat glands). 

8. Relaxes sphincters so that 

waste matter can be removed. 



SPECIAL SENSES 

Special senses include smell, taste, sight, and 
hearing. 

Smell 

This is one of the most primitive of the senses. 
Odor is perceived by stimulation of cells in the 
olfactory membrane of the nose. Smell is not as 
well developed in man as in other animals. 

Taste 

Taste buds are located in the tongue. The sensa- 
tion of taste is limited to sour, sweet, bitter, and 
salty. Many foods tasted are actually smelled, and 
their taste depends upon their odor. We can 
demonstrate the tastelessness of some foods by 
holding our noses when we eat them. 

Sight (the Eye) 

The eye is a specialized organ for the reception 
of light. The optic nerve conveys the impulses 
from the retina to the visual area of the brain. 
The eye is like a camera ; it has an opening in the 
front, called the pupil, for the entrance of light, 
and a lens behind the opening to focus the rays 
of light and form an image on the retina in the 
back of the eyeball. The nerve endings for the 
sense of sight are shaped like tiny rods and cones 
standing on end side by side in the retina. They 
are so sensitive and so close together that points 
on the retinal image can be seen as separate points 



ANATOMY AND PHYSIOLOGY 



47 



Conjunctiva 
Cornea 



Aqueous 
humor 

Ciharcj bodij 



Ant. chamber 
Iris 



Crqstalhne 
lens 




Sclera 
Choroid 
Retina 



Optic nerve 



fovea Centralis 



/ 



Figure 40. — Diagram of the Eye. 

when they are less than ',,, of an inch (tun 

mm.) apart. 

The eve is divided into an anterior chamber 
and a posterior chamber with the crystalline 
lens between. The anterior chamber contains a 
watery solution called aqueous humor, and the 
posterior chamber is tilled with a jellylike Bub- 
stance called vitreous humor. The eye is com- 
posed of three layers <>t' t issue : 

1. The sclera— the white pari Of the eye which 
is the protective outer layer. In front, t he sclera is 
transparent and known as the cornea. Around 
the cornea the exposed part of the eye is covered 
with mucous membrane, the conjunctiva. 

•2. The choroid is the middle, vascular layer of 
the eyeball. The iris, containing radiating and 
circular muscles which can make the pupil larger 
or smaller, is the colored portion of the choroid 
just behind the cornea. The opening in the iris 
is ccjled the pupil. 

The retina is the inner coat of the eye, con- 
tai'\Jlg the light receptor- (rods and cones). The 
sit- f the exit of the optic nerve, lacking rods 
at >nes, is called the "blind spot." 

ability to see objects clearly at different 

es is accomplished by changing the thick- 

j the lens to bring an object into locus. This 

\ is called accommodation. 

optic nerve is the sensory pathway for 

POST _ • ■ 

riBh S received in the. retina bv the tods and 



i 



Hearing (the Ear) 

The ear IS divided i Nlo three part - : the ■ x : . i n:t I 

ear, middle ear, and internal ear (fig. 11). 

1. The external em i- known as the auricle. It 
is composed of carl ilage covered by skin and pro- 
jects from the Bide of the head to receive sound 

vibrations. Sound waves are conveyed through 

the external auditory canal to the eardrum. The 
BOUnd Waves cause the drum to vibrate Tht 
vibrations are picked Up bj the inner bone- of lin- 
ear and transmitted by the auditor] nerve to the 
brain. 

•_'. The middle ear i- an air-filled -pare in the 
-kull containing three tinj bone- called ossicles. 
These bom- transmit Bound waves to the internal 

ear. The middle ear i> connected with the throat 

by the eustachian tube, which serves to equalise 

air pie— lire in the middle ear with that of 

atmosphere. 

:'.. The internal ear contain- the receptor 
organs tor hearing. Nerve impulses are trans- 
mitted by way of the auditon nerve to the brain. 




y. 



INNER EAR 

Semi- circular 
canals 



Cochlea 




Auditors 

Nerve 
fenestra ovahs 
Fenestra rotunda 



MIDDLE EAR 
Malleus 

incus 

Tqmpanic mem 
Stapes 




Figure 41. Diagram of the Ear. 

Equilibrium 

In each internal ear there aie three -emicircu- 
lar canal-, a utricle, and a Baccule. < "haiiL'e- in the 
position of the head Causes movement of tluid 

within these canal-. This movement tered 

on a branch of the BCOUStic nerve and relaxed to 
the bra in. BO if von tip your head to one ride, VOU 

are made aware of this by the nerve of equilibrium 

from \ our middle ear. 



48 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Special Functions 

Speech is controlled by coordinated action of 
several nerve functions. The speech center is lo- 
cated deep in the brain, and from it nerve impulses 
pass out to the larynx, which contains folds of 
mucous membranes called vocal cords. When air 
is forced from the lungs past these folds, certain 
sounds are produced, and in conjunction with the 
movements of the throat, lips, tongue, and teeth, 
articulate speech results. 

Sleep is a period of unconsciousness when the 
higher physical powers are quiet, but during sleep 
body activities continue. It is usually considered 
a period of rest, in which constructive processes 
build up and repair the body. Certain changes 
take place during sleep: respiration is slowed; 
less blood is sent to the brain ; and greater amounts 
go to the extremities. Digestion goes on but at a 
slower rate during sleep. Body temperature may 
drop somewhat, and the heart action is slowed. 

Heat regulation, or maintaining body tempera- 
ture, is accomplished by controlling heat loss and 
heat production. Heat is lost through the excreta, 



expired air, evaporation of sweat, and radiation 
and conduction from the skin. Heat is produced 
by burning food within the body, and by muscular 
activity. 

The preservation and elimination of heat is con- 
trolled chiefly by the -autonomic nervous system, 
through the nerves to sweat glands and blood 
vessels. An increase of blood to the skin increases 
the loss of heat by radiation ; heat may be retained 
by decreasing the amount of blood to the skin. 

Fever is an abnormal condition of increased 
temperature, usually brought about by disease or 
certain toxic substances. These act upon a heat 
center in the brain, which influences the body 
through the autonomic nervous system. 

Other Senses 

Body tonus and position sense, as well as pain, 
temperature, and touch are carried through special 
nerves in the skin and underlying tissues. Other 
nerve receptors, located in muscles and tendons, 
are stimulated by changes in tension and pressure, 
and serve to inform the higher centers regarding 
the position of parts of the body. 



i 



PLATE 1 



48< 




Chapter III 

FIRST AID AND EMERGENCY PROCEDURES 



INTRODUCTION 

First Aid is the emergency treatment <>f the 
sick or injured before regular medical or surgical 

attention can be obtained. It Bhould neither 
Supersede DOr take the place of proper medical 
or surgical attention, and should consist of fur- 
oishing temporary assistance to a sufferer pend- 
ing the arrival of competent medical aid. 
The purposes of first aid are: 

1. To save lite. 

2. To prevent further injury. 

:'.. To preserve resistance and vitality. 
A real knowledge of first aid and its purpo.-i 9, 
when properly applied, may mean the difference 

between life and death, between rapid recovery 
and long hospitalization, between temporary dis- 
ability and permanent injury. 

Knowing when to. what to. and how to apply 
first-aid measures for the many and various con- 
ditions that confront the hospital COrpsman in 
emergency requires a great deal of knowledge and 
a continual studious effort on his part to keep 
abreast with the changes in and the newer con- 
cepts of first aid treatment. 

Minor Surgery is that part of surgery that in- 
cludes procedures not endangering life. It in- 
cludes the application of bandages, splints. < 1 1 * — 
ingS and sutures, eounterirritat ion. cauterization, 
and similar simple surgical measures. 

General Procedures in Case of Injury 

Observe the following rules: 

1. Keep the patient lying down with the head 
level until his injuries have been determined. 

•2. Examine the patient for hemorrhage, <• 
tion of respiration, and evidence of poisoning. 
These conditions take precedence in this order 
over everything else and demand immediate 
treatment. 

3. Remove enough clothing to get a clear idea 
of the extent of the injury. Preferably rip the 



clothing along the -cam-. Imt cut it if usees 
Removing clothing in the usual way may do great 
harm, especially in Fractures. Do not remove too 
much clothing; exposure to cold may precipitate 

the condition of shock. 

■I. Do not get excited. Act quickly hut effi- 
ciently. Decide a- soon as possible what ! 

he done and which one of the patient's injurie- 
need- alteiit ion first. 

5. Keep the patient com fortahle. Thi- can be 
done while the patient's injuries are being cared 
for. A blanket over the patient ma\ do him a- 

much good a- the dressing one appliet to bis 
wounds. 

6. Avoid allowing the patient to see his injury. 
Assure him that bis injuries are understood and 
that he will get good (are. In some cases a I ig 
arette will make a patient feel better. These little 

thiiiL^ are important in determining a patient'.- 
final outcome and prevent nil' -hock. 

7. Do not touch open wound- oi bin n- with your 
finger.- or other objects. This may cau-e serious 

infect ions and may cost the patient his life. 

8. Do not try to give an unconscious patient 
liquids. 

!>. Do not move a patient until the extent of his 
injuries has been determined. 

HEMORRHAGE 

Hemorrhage, or bleeding, is the escape of blood 
from the arteries, vein-, or capillaries because of a 

break in their w alls. 

The average adult body contains about .". quarts 
of blood. One pint can usually be lost with no 
harmful effects. Tin- is the average amount given 
by blood donors. The rapid lo— of about 1 quart 

will produce symptoms li-ted below, the greater 

the lo-- the more pronounced the symptoms. The 
lo-- of a quarter of the blood volume i- dangerous, 

the lo— of one half of the blood volume i- usually 
fatal. 

49 



50 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Spontaneous hemorrhage (not caused by in- 
jury). — Caused by conditions such as straining, 
coughing, and arterial or venous hypertension. 

Traumatic hemorrhage (caused by external 
forces). — Caused by conditions such as cutting 
with sharp instrument, heavy blow of an object, 
compound fracture, and traumatic amputation. 

Arterial hemorrhage. — Blood is bright red, 
gushes forth in jets or spurts that are synchronized 
with the pulse. 

Venous hemorrhage. — Blood dark red, escap- 
ing in a steady flow. 

Capillary hemorrhage. — Blood intermediate in 
color, oozes from the wound. 

Symptoms and Diagnosis 

External hemorrhage can be seen and is easily 
recognized. Internal, or concealed, hemorrhage 
is sometimes difficult to diagnose. Symptoms are 
easily confused with those of shock. 

The following symptoms are usually present 
both in internal and external hemorrhage, the 
degree depending on the amount and rapidity of 
blood loss : 

1. Skin pale, moist, clammy. 

2. Temperature may be subnormal. 

3. Pulse rate will usually be increased, feeble, 
easily compressible and lost. 

4. Blood pressure may be lowered. 

5. Pupils of eye usually dilated and slow 
reacting. 

6. Tinnitus — ringing in the ears. 

7. Restlessness and twitching; displays anxiety. 

8. Patient complains of thirst. 

9. Air hunger, with yawning. 

10. Impaired vision; the greater the loss of 
blood the greater the vision will be dimmed. 

In addition to the above causes, concealed hem- 
orrhage may be caused by punctured wounds; 
wounds that have been closed by sutures, espe- 
cially deep wounds; heavy blows rupturing in- 
ternal organs; spontaneous rupture of internal 
vessels; and numerous other causes that will be 
discussed later. These factors must be borne in 
mind in examining an individual with the above 
symptoms. 

Treatment 

The following are various methods used in con- 
trolling hemorrhage: 



1. Place patient at rest, administer morphine 
(one-fourth grain). 

2. Elevate the part if an extremity. 

3. Manual pressure over pressure points. 

4. Cold applications. 

5. Local hemostatic (styptic). 

6. Direct or indirect pressure, using pressure 
bandage or tourniquet. 

7. Clamping or ligation of vessels. 

8. Suture wound. 

Note. — Do not disturb a clot while checking bleeding. 

Arterial hemorrhage. — Requires prompt and 
decisive methods particularly in cases of hemor- 
rhage from the large arteries. Manual pressure 
may be resorted to until a tourniquet is made avail- 
able. The tourniquet can only be used on the 
extremities. Pressure must be between the wound 
and the heart. Plate No. I illustrates the major 
pressure points. At these points the arteries may 
be compressed more easily against a bone. This 
plate and the inserts should be studied well, and 
the points shown impressed on the mind. The 
pulse can usually be felt with the fingers at the 
pressure points. 

A tourniquet is a constricting band. There are 
many kinds. The principle of all tourniquets is 
a pad or other object over the artery, a band around 
the limb, and some means of tightening the band. 
Any round, smooth object such as a stone, rifle 
shell, or roller bandage may be used and any 
material such as a neckerchief, belt, or bandage 
is used as the band. The object — to compress the 
artery to close it. Place hard object over pressure 
point, tighten band until arterial hemorrhage 
stops. There is great danger in the use of a tourni- 
quet. Permitted to remain in place with circula- 
tion cut off, the part below the tourniquet quickly 
becomes swollen and painful, and if permitted to 
remain long enough may cause gangrene and con- 
sequent loss of the part. The tourniquet should be 
loosened every 15 minutes. If bleeding recurs, 
tighten immediately. If patient is to be trans- 
ported, do not cover the tourniquet with a blanket 
without being certain that the attendant knows 
of the tourniquet. Never cover a tourniquet with 
a bandage or dressing. Never use a tourniquet 
if other means will stop the hemorrhage. 

Arterial hemorrhage, especially from the fem- 
oral artery, is often difficult to stop with a tourni- 



FIRST AID AND EMERGENCY PROCEDURES 



51 



quet. If this large artery i.- severed, only a mat- 
ter of minute- remain in \\ bich to work. Drasl ic 
measures are essential. If nothing else is avail 
able, reach in the wound with the thumb and fore 
finger, grasp the t*ntl of the artery, twisl u few 
times, and either hold until aid arrives or tie with 
a piece of string, [f sterile items are at hand use 
them, but do not wait if they are not. The danger 
of infection must I >t - sel aside to save life. If no 
other means are available and the artery cannot 
he reached for ligation (tying off), and a tourni- 
quet will stop the hemorrhage, then use it, even 
though it may have to remain in place for a long 
period of time. It is better to chance the loss of a 
limb of the patient than his life. 

Venous hemorrhage. — This may be controlled 
by the use of dressing and tight bandage over the 
dressing An extremity may he tightly bandaged 
from the toes or fingers up to the bleeding point. 
This with elevation of the part may stop the 
bleeding. 

Note. — In the majority of cases a pressure dressing will 
suffice t" control externa] hemorrhage. 

Capillary hemorrhage. — This can usually be 

controlled with a compress and bandage. It may 
be necessary to use a styptic: alum, adrenalin, or 
tincture of ferric chloride being the more common. 
Internal, or concealed hemorrhage. — May be 
caused by deep wounds, heavy blows that rupture 
internal vessels, certain diseases and conditions. 
The symptoms will be as listed except ability to 
see the hemorrhage. Recent history of trauma 
will he an indication. It must he remembered 
that shock gives symptoms similar to those of in- 
ternal hemorrhage. If there is much loss of 
blood, shock will develop. There may be shock 
present from a heavy blow. This requires the 
service's of a medical officer as soon as possible. 

First Aid Treatment 

1. Place the patient at rest 

•2. Apply ice bag over part if it is certain that 
hemorrhage i> present. 

:">. Keep patient quiet 

4. Administer morphine. 

Lung hemorrhage (hemoptysis). — May result 
from wound of the lungs, more often from disease. 
Usually starts with lit of coughing. Expectorates 
bright red blood, usually frothy. 



Treatment : 

1. Place patient at rest, absolutely quiet 

•_'. be bag to chest 

8. Medical officer summoned at once. 

I. Small pic,- ci cracked ice maj be given by 
mouth. 

.">. No 8< itnulants of any kind. 

6. Patient ma\ be turned on affected Bide to pre 

vent the blood fn>ui entering the unaffected lung. 

Stomach hemorrhage ( hematemesis) /- I': 

tient usually vomits, blood i- usually dark colored, 

clotted, and may he mixed with food. Blood may 
have been swallowed from nosebleed. Inquire >^ 

to recent trauma id any kind, including extracted 

teeth. 

Treatment. Is same a- fur hemorrhage of 
lungs except ice bag i- applied over upper part 

of abdomen. Morphine sulfate i 1 , grain i may 

be given. 

Nasal hemorrhage from nose i e] — 

1. Have patient remain quietly in Bitting | 

tion. Loosen collar. 

'J. Place cold pack- at back of head. 

:'.. Instruct patient t<> breathe through the 
mouth, and not to blow the i 

4. Nostrils may he packed with a piece of cut- 
ton or gauze that ha- been dampened with adren- 
alin, l : l I solution. 

.">. If these method- fail, summon a medical 
officer. 

Hemorrhage from a compound fracture may be 
controlled by pressure applied to main compres- 
sion point of the area involved until clot formation 
appears, or by direct pressure over the area with 
sterile compresses. 

ASPHYXIA 

Asphyxia is a condition where respiration, or 
breathing, ha- ceased. It may be the result of 
either abnormal physiological or physical causes. 

When due to the latter it may be spoken of a- -uf- 

focation. Among the physiological causes i 

phyxia are : Lack of -i iniiil.it ion of the respiratory 

center, and inability of the blood to absorb OX 
from the lungs or to effect the normal exchange of 
ga-e- in the bod\ ti--ue-. In asphyxia resulting 

from physical causes, the lungs are deprived «»f air 
because of stoppage of the air passage mechani- 
cally, as by water in drowning, by a foreign body. 



52 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



by a diphtheritic membrane extending into the 
larynx, by a swelling of the mucous membranes 
following inhalation of live steam or an irritating 
gas, by a constricting band around the neck com- 
pressing the trachea ; or because of the presence of 
irrespirable gases in the air. 

Treatment : First remove the cause or remove 
the patient from the cause, then give artificial 
respiration, and later treat for shock. 

Artificial respiration is used to induce breath- 
ing in persons whose respiration has stopped. The 
common causes of respiratory failure where arti- 
ficial respiration has value are : Drowning, suffo- 
cation, electric shock, and poisoning by illumi- 
nating gas or carbon monoxide. Artificial 
respiration is also used occasionally in certain 
illnesses, such as poliomyelitis. Poison gases and 
nerve gases used in warfare may cause respiration 
to cease. Attempts to start respiration after 
breathing has stopped are made either by mechani- 
cal or manual methods. Mechanical methods re- 
quire the use of machines that usually are not on 
hand when most needed. Manual artificial res- 
piration, which can be conducted by anyone 
familiar with the methods, can be started immedi- 
ately and can be continued until breathing has 
started or until mechanical respirators become 
available. 

Instructions for Artificial Respiration 

Certain general principles must always be kept 
in mind in performing any method of artificial 
respiration. 

1. Time is of prime importance. Seconds count. 
Do not take time to move the victim to a more 
satisfactory place; begin at once. Do not delay 
resuscitation to loosen clothes, warm the victim, 
apply stimulants, etc. These are secondary to 
the main purpose of getting air into the victim's 
lungs. 

2. Quickly place the victim in the prone position, 
that is, on his abdomen, with the face turned to 
one side, the elbows bent, and the cheek resting 
on the back of the hand. 

3. Quickly sweep your fingers into the victim's 
mouth, removing froth and debris and drawing 
the tongue forward. 

4. Begin artificial respiration and continue it 
rhythmically and uninterruptedly until spontane- 



ous breathing starts or the patient is pronounced 
dead. 

5. As soon as the subject is breathing for him- 
self, or when additional help is available, see that 
the clothing is loosened (or removed if wet) and 
the patient is kept warm. However, do not inter- 
rupt the rhythmical artificial respiration to accom- 
plish these measures. 

6. If the victim begins to breathe on his own, 
adjust your timing to assist him. Do not fight 
the victim's attempt to breathe. Synchronize 
your efforts with his. 

7. Do not wait for a mechanical resuscitator, but 
when an approved model is available use it. A 
well-performed "push-pull" type manual method 
is immediately available and effective and accom- 
plishes adequate ventilation. The mechanical re- 
suscitation is no more effective than a properly 
performed "push-pull" manual technique. The 
most important adavantage of good mechanical 
resuscitators is that they require less skill to oper- 
ate, are not fatiguing, and can furnish 100 percent 
oxygen. There are other advantages. Since the 
resuscitator need only be applied to a patient's 
face, it can be employed when physical manipula- 
tion of the body is impossible or would be harm- 
ful, as during surgical procedures, in accident 
cases with extensive burns, broken vertebrae, ribs, 
arms, etc., and for victims trapped under debris 
of excavations, overturned vehicles, etc., and dur- 
ing transportation of the victim. Furthermore, 
some resuscitators signal when the airway is ob- 
structed and provide an aspirator. 

Arm-Lift Back-Pressure Method 

1. Position of subject. — Place the subject in 
the face-down prone position. Bend his elbows 
and place his hands one upon the other. Turn his 
face to one side, placing his cheek on his hand. 

2. Position of the operator. — Kneel on either 
the right or left knee, at the head of the subject, 
facing him. Place the knee at the side of the sub- 
ject's head close to the forearm. Place your hands 
on the flat of the subject's back in such a way that 
the heels of the hand lie just below a line running 
between the arm pits. With the tips of the thumbs 
just touching, spread the fingers downward and 
outward. 

3. Compression phase. — Rock forward until 
the arms are approximately vertical and allow the 



FIRST AID AND EMERGENCY PROCEDURES 



53 







mis,;,;"— 53 5 



54 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 







FIRST AID AND EMERGENCY PROCEDURES 



55 



weigh! of the upper pari of your bod} to exert 
slow, steady, even pressure downward <>n the 
hands. This forces air out of the Lungs, four 
elbows should In- kepi straighl and the pressure 
exerted almost directly downward on the back. 

!. Expansion phase*— Release the pressure, 
avoiding a final thrust, and commence to rock 
slowly backward. Place your hands upon the 

Subject's anus ju>t above his ell-ow 9, and draw his 
arms upward and toward you. Apply ju-t 
enough lift to feel resistance and tension at the 
subject's shoulders. Do not bend your elbows, 

and as you rock backward the subject's arms will 
he drawn toward you. Then drop the arm- gently 

to the ground. This completes the full cycle. 
The arm-lift expands the chest by pulling on the 
chest muscles, arching the hack and relieving the 
weight on the chest. 

The cycle should he repeated 12 times per min- 
ute at a steady, uniform rate. The compression 

and expansion phases should occupy about equal 

time, the release periods being of minimum 
duration. 

Additional Directions 

It is nil important that artificial respiration, 
what initial, be started quickly. — Then 1 should 
he a slight inclination of the body in such a way 
that fluid drains better from the respiratory 

passage. The head of the suhject should be ex- 
tended, not flexed forward, and the chin should 
not sag lest obstruct ion of the respiratory passages 
occur. A check should he made to ascertain that 
the tongue or foreign objects are not obstructing 
the passages. These aspects can he cared for when 
placing the subject in position or (shortly there- 
after) between cycles. A smooth rhythm in per- 
forming artificial respiration is desirable, hut 
split second timing is not essential. Shock should 
receive adequate attention, and the subject Bhould 
remain recumbent after resuscitation until seen by 
a physician or until recovery seems assured. 

The Hip-Lift Back-Pressure Method 

The hip-lift method is used when the arm-lift 
method is not practicable, such as fractures, burns, 

etc. 

1. Step 1. — Place the patient in a prone posi- 
tion, face down. The arm, on the side toward 
which the face is turned. i> extended beyond the 



head, and the other i- lent at the ell.ow and the 

hand or forearm i- placed beneath the bead, 

2. Step 1. I operator then kneels on one 
knee (whichever ia the most comfortable) astride 

the patient's thighs, facing toward the head, and 

places the palm- of in- hand- on the lower part 
"t the thorax, the little fingers touching the lo? 
rib and the end- of the fingers just out of sight. 
Thru keeping the arms straight, the operator 
-w ings In- bod} Blowly forward, causing the fiai 

I'- press upward and inward. I hi- compr<— e- 

the abdomen and the lower pari of the thorax, 

force- out the air in the lungS, and produces an 

expiration. At the end <.f the forward swing, 
the operator's shoulders Bhould !»• directly above 

the heel- of the hand-. Hold the j n < — n i c 
inoinentarilv. 

•".. Step ."}.— Then quickly bring the hand- had; 

along the sides of the patient to the hips, gn 

ing the hip- and pulling upward in a single 
motion. At the end of the upward motion the 

hip- are released and the operator goes back t.. 
his original position. Tin- procedure is com 

pleted 12 to l."» time- a minute. 

The Schaefer Method 
The following is the prone pressure method of 

art iticial re-pirat ion. 

1. Place the patient face down on blanket, ! 

at side, cheek resting on hand. Straddle both 
le^rs of patient. 

2. Extend the arm- with the hands placed on 
both sides of the chest with the thumb close to 
fingers and little finger over the last rib. 

■">. Rock forward with elbows straight, bring- 
ing your weight on the patient"- chest. Then re- 
lease pre-- ii re and return to original position. B 
peat 12 to 15 times per minute. 




Figure 45. — Th» Schaefer Method of Artificial Respiration. 



56 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



The Eve Resuscitation Method 

The following is the proper procedure for ad- 
ministering the Eve resuscitation method. 

1. Place patient on board or litter, arms ex- 
tended and wrists and ankles secured. 

2. Lift and lower each end of litter alternately, 
maintaining a rate of 12 to 15 complete cycles per 
minute. 

3. Continue this until breathing is adequately 
established or death is apparent. 





Figure 46. — The Eve Method of Artificial Respiration. 

Lightning and Electric Shock 

Lightning and electric shock may cause instant 
death or may cause unconsciousness, cessation of 
breathing, and all degrees of burning. Patients 
who have been shocked by an electric current must 
be removed as quickly as possible from contact 
with the source of electricity. This removal must 
be accomplished without the rescuer coming into 
contact with the electricity. If the patient has 
ceased to breathe, artificial respiration should be 
instituted and maintained until all hope of re- 



covery is gone or normal breathing has com- 
menced. Electric burns should be treated in the 
same manner as any burn. 

Poison and Nerve Gases 

For treatment of asphyxiation from poison and 
nerve gases refer to the chapter on Chemical 
Warfare. 

MECHANICAL RESUSCITATORS 

A mechanical resuscitator, now available for 
issue, is listed in the catalogue of Medical Materiel 
as "Resuscitator, Inhalator and Aspirator, Port- 
able ; Intermittent positive and negative pressure, 
automatic cycling. Complete with adult and child 
face masks and airways, in carrying case." 

Every hospital corpsman, who may have occa- 
sion to use this resuscitator, should carefully study 
the booklet of instructions on operation and care 
of the resuscitator in order to be able to operate 
it at a moment's notice. 

This type of apparatus is used as (1) resuscitator 
(2) inhalator (3) aspirator, under the following 
conditions : 

Used as resuscitator. — When there is no 
breathing, such as in drowning. When breathing 
is difficult, slow or shallow, as in acute cases of 
asthma. 

Used as inhalator. — When the recipient re- 
quires more oxygen than is normally in the air, 
due to such conditions as shock; poor circulation 
of blood principally caused by one or more heart 
conditions; damage to lung tissue caused by ir- 
ritating fumes or gases. 

Used as aspirator. — It clears the mouth, nose, 
and throat of mucus or blood so that the oxygen 
can reach the recipient's lungs (the aspirator can 
be used during resuscitation or inhalation if the 
air passages become clogged with mucus or 
blood). 

The apparatus consists of oxygen tank, with 
couplings; pressure gage; rubber diaphragms in 
metal resuscitator; connecting hose; face masks, 
both adult and infant size (these masks are made 
of plastic with a soft rubber cushion base that can 
be made airtight and at the same time transparent 
so that it can be seen through. The patient's face 
can be watched without having to remove the 
mask). Wire metal airways for both adults and 



FIRST AID AND EMERGENCY PROCEDURES 



57 



infant-: rubber catheter for use with aspirator; 
aspirator; extension hose to enable the operator 
(o work in tight plan- or ai a distance of aboul 
25 feel from the oxygen tank. 

To operate. — Place patient in supine position 
(on back, face up). The patient's ears should be 
in line with shoulders, not forward or backward. 

If it is desired to prevent increased blood flow 
to the head as in certain heart conditions, elevate 

the head and shoulders. 

In other cases w here it is desirable that the blood 
go to the head, the lower extremities should be 

elevated and the head and shoulders lowered, a- 
in cases of shock. 

Remember that these are desirable positions. 
The resuscitator can be used with the patient in 
almost any position. Circumstances must dictate 

this. 

The operator's [eft hand should hold the jaw up 
and slightly forward to help keep the throat pas- 
sage open. 

The tongue should lie in the center and Hat on 
the floor of the mouth. The metal wire airway. 
if used, is placed on top of and in the middle of 
the tongue, to keep the tongue from curling hack- 
ward over the windpipe opening. 

Before starting resuscitator, remove any ob- 
structions present in the mouth or air pa- 
such as false teeth, gum, tobacco, blood, or mucus. 

Use aspirator for the latter. 

If possible, the operator should work from 
behind the patient's head in operating the resusci- 
tator and observing the patient. 

Hold the jaw up with loft hand. With the 
right hand place the mask from the side of the face 
over the patient's nose and mouth. Keep the mask 
in place by placing the thumb over the cushion 
at the bridge of the nose, the index and middle 
linger over the plastic mask and cushion just over 
the jaw. The ring and little fingers should be 
uuiler the jawbone to hold it up and slightly 
forward. 

The mask is in place if the indented part of the 
cushion rests on the bridge of the nose anil it- 
edge lit- snugly all around. 

The mask must he airtight on the patient's face 
or oxygen will be lost. The -oft rubber cushion 
on the mask aids in making a seal to prevent 
o.w gen l< 



Turn indicator to the amount ol 

required. 

To -tart OXygen tlou attach the metal 

tator to the fa«c mask and push the hose into the 
knurled ring on the resuscitator. This will start 
the oxygen flowing ami the operation i- then 

automat ic. 

K. ep the air p free of mucus bj use ol 

the aspirator. Aspirator i- attached to the oxy- 
gen hose in place of the resuscitator and releasing 
the trigger on the aspirator causes the oxygen to 

pull a vacuum in the aspirator. 

With this respirator, the patient cannot be given 
too much oxygen. Only that which can be used is 
released at the time of use. Bven with the valve 

wide open to let the maximum amount of OXygen 

into the respirator, only that which i- hcin^ used 

will pa-- through the respirator. 

Warnings and Precautions in the Use and 
Care of the Aspirator 
Keep oil and grease awaj from the tank valve 

and resuscitator yokes. Never change tank- with 

oil or grease on hand-. 

Never boil or autoclave plastic face masks. 

Never pull on hose attached to knurled rii . 

resuscitator. It never comes completely off. This 
hose -nap- out of ring to turn ofl oxygen, hut it 
is not removed. 
When the apparatus is stored, mak 

That it ha- heen thoroughly cleaned. (Air- 

ways, masks and cushions, wash with warm Boapj 

water, rinse well ami dr\. Powder >u-hion- 

lightly. Keep cushions inflated.) 

That it ha- heen checked thoroughly. See that 
all part- are working. 

See that all part- ale -ti.ied in the proper place. 
I i the machine at least once each month. 1 k) 

not merely open the case, but put the parts together 

ami actually run the machine for a minute or two, 

ertain that the oxygen pressun bows 

sufficient oxygen in the cylinder. 

This i- an excellent time to hold instruction in 
the USB of the apparati, I'. Certain that all 

hand- have an opportunity to actually operate 'he 
apparat us. 

Make certain that the hooklet of instruction 
is kept in the holder provided for it. in the lid 

of the carrying case! and that all personnel 



58 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



thoroughly read and understand these instruc- 
tions. 

Remember that you and the apparatus are a life- 
saving team. Both must do a good job. Unless 
the operator has a thorough knowledge of the ap- 
paratus and knows how to operate it properly, 
neither the apparatus nor the operator can do 
a good job. 

SHOCK 

Shock is the sudden depression of the physical 
and mental processes of the body resulting from 
most injuries (some degree of shock follow all 
injuries, it may be slight, lasting only a few 
minutes, or it may be prolonged). The nervous 
system which controls these vital functions may 
be likened to a system of electrical wiring. If too 
heavy an electrical current is made to traverse the 



.EYES 
Vacant 
Lackluster 
Pupils Dialated 



..BREATHING 
Shallow 
Irregular 




NAUSEA 



PULSE 
Weak or 
Absent 



Figure 47. — Look for These Symptoms in Shock. 



wires in an electrical system they are likely to be 
burned out, or fuses blown. Similarly, if too 
violent impulses traverse the nerve paths in the 
body, there may be death from complete non- 
functioning of the nervous system, or there may 
result a much milder condition in which there is 
only partial functioning of the same. As the 
nervous system controls the mental and physical 
processes of the body, so in shock they are all 
more or less affected. Practically any impulse 
traversing the nerve paths, if severe enough, may 
cause shock. There is emotional shock, where 
the impulses originate in the brain ; traumatic 
shock, which results from a severe blow in the 
solar plexus or testicle, or from crushing or cutting 
a large nerve trunk, or from some severe injury; 
and electrical shock, resulting from a heavy elec- 
tric current traversing the nerve paths. 

One of the main effects of too violent impulses 
on the nerve track is the loss of nerve control over 
the blood vessels, resulting in the circulating blood 
collecting in the veins, especially the large veins 
of the abdomen and depriving the brain and other 
parts of the body of their normal supply. More 
or less, shock occurs from all injuries, depending 
upon the stability of the nervous systems of in- 
dividuals; what might cause a mild case of shock 
in one would cause a severe case in another. 

Symptoms of Shock 

1. In early shock feeling of weakness, faintness, 
dizziness, and often nausea. 

2. General typical appearance — at first pale, 
then ashen. Skin cold and clammy from per- 
spiration. In some cases there is cyanosis or 
lividity due to the delayed filling of the surface 
blood vessels, especially in the arms and legs. 

3. Expression of acute anxiety, restlessness and 
apprehension. 

4. Complains of thirst. 

5. Pupils dilated and eyes have a glassy or 
vacant stare. 

6. The heart sounds are faint and distant. 

7. Rising pulse rate. In severe cases it may 
rise to 160 or more per minute, becoming at the 
same time weak and thready. 

8. Respirations faint, shallow, and rapid. 

9. Falling blood pressure, the blood pressure 
drops as a result of the depression in circulation, 
this is one of the most constant features of a de- 



FIRST AID AND EMERGENCY PROCEDURES 



59 



veloping shock. There is a so-called "dangerous 
blood pressure level" in the neighborhood of 50 
nun. of mercury. II' a patient's blood pressure 
remains below this critical level for a number <>f 

hours, the resulting Lack of hi l with oxygen to 

the brain and other body tissues may produce 
irreparable damage after which no form of treat- 
ment <an save the pal ient's li IV. 

LO. At lirst the patient a|>|>cai- calm and ra- 
tional. Inn as the state of shock progresses and 
there is deficient circulation to the brain, greater 
stimuli arc necessary to produce any response 
from the patient. Finally a stupor may set in 
(patient is in a state of mental confusion ). 

It is of paramount importance that the treat- 
ment of shock he commenced at the earliest possible 
moment so as to limit its severity to a minimum. 
Prolonged deep shock may produce such extensive 

damage that subsequent treatment cannot save the 

patient's lift'. First aid treatment should consider 

the prevention as well as the therapy. 

Emergency Treatment 

1. Place the patient in the proper position 

which should he a horizontal position with head 
lowered. The circulat ion in shock is unstable and 
placing the patient in this position provides for 
a flow of blood to the brain. Rest and quiet are 
essential. (Treat the cause at the same time.) 

2. Keep the patient warm by use of blankets. 
A warm drink may be given the patient if he is 
conscious. Do not warm tin- patient with arti- 
ficial means, such as hot water bottles, as by warm- 
ing the body by this method the blood is drawn to 
the surface into the dilated blood vessels and away 
from the vital organs. 

3. Morphine: If the patient is conscious give 
1 | grain of morphine by hypodermic injection (one 
syrette contains U or ' | grain). If the restless- 
ness and pain continue- after a reasonable length 
of time (30 to 45 minutes), a ' ^-grain additional 
dose may he necessary for the relief of pain and is 
essential to prevent further shock ; however, in the 
average case it will not he necessary to repeat the 
morphine at less than 4-hoUT intervals, and then 
only if the pain demands. Caution must be 
observed in repeating morphine injections as an 
overdose will cause a depression of the depth and 
rate (under 1.') per minute) of respiration through 
direct effect on the respiratory center. Contrac- 



tion of the pupils (pin point in si/ei which may 
he \civ marked, is a \aluahle Warning "t • 

dosage. Patient's with head injuries who are 
conscious and in pain may he given Phenobarbi- 
tal 1 1 _. grains. Morphine should nevet be given 
in the case of fu </*/ injui 

$ am patients given morphine in the field Bbonld 

be marked with an "M" on the forehead "r thin Information 
must be accurately recorded on the emergency medical 
tag, 

I. Hemorrhage*— Bleeding must be stopped at 
once by methods described under bemorrli 

•">. Fluid replacement. — Fluids to re establish 
an effective blood volume and pressure t<» normal 
should be supplied as Boon as possible Normal 

blood plasma injection- are most universally u-< d. 

Serum albumin, which comes in -mailer contain* 

than plasma, is available. If neither of thl 

fluids are available, a solution of 9 grams of 
diiim chloride in l.oon <•,-. of sterile distilled water 
should be given intravenously. The use of whole 
blood in most circumstances is the ideal fluid for 
this purpose, hut because of it- nature it is difficult 
to preserve, supply, and administer. The admin- 
istration of whole blood i< limited to medical 
officers. 

Plasma 

In estimating the dosage of plasma it i- at 

-ai v to Consider the extent ami degree of the injury 
a- well a- the age and condition of the patient. 

1. Patients exposed to obvious cause for shock 

hut clinical symptoms not yet apparent. 250 l<> •" 

i-c. 

2. Patient- who give indication of early, mod- 
erate shock. 25' ' T « > 7-"' 11 CC. 

:;. Patients in severe shock, 750 to I, 

4. Extreme shock (usually long untreated), 

1.: to 3,000 cc 

The first 250 to ;.<*i <•<■. administered a- rapidly 

as possible. Kepeat a- often a- necessary. 

... Severe bum cases, whether in great shock or 

not. give at lea-t i . -ure l<> de 

velop and will overwhelm the patient before a Suffi- 
cient amount of plasma can be given. 

a : • * ii ible l( ngtb "f ttaw 
plasma should be allowed t" observe t 1 
tiim-: if itie reaction is favorable time* un« 

to give mere plaama at tli.it time. 



60 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 48. — Shock Position. 

Morphine Syrette 

This syrette is composed of a collapsible metal 
tube with a hypodermic needle attached, a stylet 
in the needle, and the needle covered with a plastic 
tube. The needle has been sterilized. The col- 
lapsible tube contains either y 2 or 14 grain mor- 
phine tartrate. (See fig. 49.) 

To use : Break seal on bottom of or unscrew the 
plastic tube and remove. Grasp stylet at top and 
push into the tube until circle at top of stylet is 
stopped by guard. Remove stylet and use as hy- 
podermic syringe, with sterile technique. 



m 



^LASTIC TUBE 
,.GUARD 
-STYLET 

—NEEDLE 



..METAL SEAL 



I. -COLLAPSIBLE TUBE 



Figure 49. — Morphine Syrette. 

BLOOD PLASMA 

Normal human plasma dried, or as commonly 
referred to, blood plasma, is issued as a unit. This 
unit consists of one cardboard box, which contains 
two cylindrical tins, hermetically sealed. A key 
for opening is attached to the bottom of each tin. 



Directions for mixing and administration of blood 
plasma are printed on the tin. Sterile needles and 
tubing for proper administration are sealed in the 
tins. 

1. Open metal cans with attached keys. 

2. Remove plasma and water bottles. Cleanse 
stoppers with alcohol. 

3. Remove wrapper from double-ended needle 
and remove glass tube from one end of needle. 
Remember these needles are sterile, handle accord- 
ingly. 

4. With water bottle in upright position insert 
uncovered end of double-ended needle through 
stopper into the water bottle. 

5. Caution: The bottle containing the dried 
plasma contains a vacuum to pull the water into 
the plasma bottle. If the needle is placed in the 
plasma bottle first, the vacuum will be destroyed, 
and much valuable time will be lost in getting 
the water into the plasma bottle. 

6. Elevate free end of airway assembly to pre- 
vent water from wetting cotton filter in airway. 

Caution. — If cotton in airway filter becomes 
wet — remove it. 

7. Remove glass tube from other end of double- 
ended needle. Invert water bottle and insert 
needle through stopper into the plasma bottle. 

8. Allow water to be drawn into plasma bottle. 
Caution : If vacuum in plasma bottle is lost, apply 
pressure in water bottle by forcing air into air- 
way tube. If this method fails, remove stoppers 
and pour water into plasma bottle. Replace stop- 
per on plasma bottle and continue immediately. 

9. After water is added, double-ended needle 
is removed from plasma bottle.' 

10. Shake plasma bottle until plasma is com- 
pletely dissolved. 

11. Remove coverings from short needle at- 
tached to intravenous set and insert through 
stopper on plasma bottle. 

12. Withdraw needle of airway assembly from 
water bottle and insert through stopper into 
plasma bottle. 

13. Invert plasma bottle and suspend it for ad- 
ministration. 

14. Fix glass end of airway assembly with the 
suspension tape above the inverted plasma bottle. 

15. Remove wrapper from observation tube and 
intravenous needle. 



FIRST AID AND EMERGENCY PROCEDURES 



61 






16. Attach intravenous needle to tube and re- 
move glass from needle, 

17. Allow plasma to lill rubber tubing. 



Distilled 
water 



Restored 
plosmo 




cotton 



filter— t 



airway assembly/ 



1/ 



double 
ended 
needle 



short needle 



plasma filter — -u 




Dried 
plasma 



intravenous 
needle 



Figure 50. — Plasma Administration Assembly. 



18. Lnserl needle in vein. If patienl is to receive 
additional plasma, restore second bottle as out- 
lined. Pull nut needle from first bottle and . 
m Becond bottle, while pinching intravenous tube 
'" preveni it Iron, filling with air. Elevate end 
of airwaj and ii\ ii in place with the suspension 
tape. 

N ""- Plasma ■honld be rued within :\ boon after 
restoration. 

Fluids. Manj men in shock are dehydrated. 
Plasma and serum albumin tend to restore to 
normal the blood volume by drawing water from 

sue spaces into the blood stream. Therefore, 
further tissue dehydration takes place. It ic 
sential thai fluids be given. Water is retained 
better if Ball is added. Physiological Baline solu- 
tion is of great value either administered by mouth 
or intravenously. For oral use, Ball tablets maj be 
added to water in canteens. Fluid- should be 
forced so thai the patienl will produce an output 
of 1,500 cc. of urine per day. 

Notb— Water may i»«- retained better if tnffldeol nil 

ta added t ake physiological saline solution (0.86 i*r- 

eeuti. it imist be remembered thai sail water, U strong, 
may be osed aa an emetic if the patient i- ... 
-;iit water may increase the distress. 

INFLAMMATION 

Inflammation is the local reaction of the bodj 
to irritation. It is the reaction that takes pi 
in tissue thai is injured but not destroyed. The 
signs of inflammation are redness, Bwelling, heat, 
pain, and disturbance of function. Anyone who 
has smashed a finger can testify that it became 
red and swollen, hot and painful, and that u 
finger it was useless. The same i- true ..f a boil 
on the ne.k. a cinder in the eve. rheumatism in a 
knee, or an inflammation of the throat. The five 
signs given above are present. 

These signs are due t<. the action <>f the blood 
vessels in the injured tissue. The blood vessels 

reacl to irritation by dilating. More I.I I con 

mi., the area. The blood i- warm and it i- red: 
thai accounts for two of the signs. A- the blood 
vessels dilate, their walls begin to leak and blood 
serum escapes into the tissues. Tin- accounts foi 
the swelling and also lot- the pain because n i- 
the pressure of the swelling on nerve endings 
thai causes pain. The disturbance of function can 



62 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



be due either to pain or to interference by the 
swelling. 

Even as these changes in the little blood vessels 
are producing the cardinal symptoms of inflam- 
mation, the body is reacting to the injury. The 
white cells of the blood come into the area. Within 
the dilated blood vessels the white blood cells . 
catch on the walls as the current brings them by. 
They press themselves through tiny chinks in the 
wall and escape into the tissues whei"e the irritant 
is present. Thousands of them gather, and to- 
gether they form a wall about the area and seal it 
off. Within this area the white cells work as 
scavengers (phagocytes), destroying bacteria and 
ingesting small particles of foreign matter or dead 
tissue. 

As the sources of the injury are overcome or ex- 
pelled, the tissues return again to normal. The 
white cells disperse. The blood vessels resume 
their usual size. The fluids flow away through 
the lymphatics. If tissue has been destroyed, it 
is replaced by scar tissue. The dilation of the 
blood vessels and the mobilization of the white 
cells against agents that injure the body are the 
two basic reactions in the process of inflammation. 

Causes of Inflammation 

Inflammation plays an important part in frac- 
tures, dislocations, sprains, strains, wounds, burns, 
frostbite, and many kinds of infection. A classi- 
fication of the causes of inflammation follows : 

Traumatic, such as blows and mechanical irrita- 
tion. 

Chemical, such as stings of insects, mustard gas, 
venom of serpents, poison ivy, acid, etc. 

Thermal, heat and cold. 

Microorganisms, such as staphylococcus, strep- 
tococcus, etc. 

Other agents, such as electricity, X-rays, actinic 
rays of the sun, etc. 

Treatment of Inflammation 

The general principles involved in the treatment 
of inflammation are : 

1. To remove the exciting cause. 

2. To keep the inflamed part at rest. 

3. To reduce the local blood pressure by eleva- 
tion of the part. 

Other agencies employed in the treatment of 
inflammation are heat and cold, wet dressings, and 




Figure 51. — Location of Principal Lymph Nodes. 

ointments. Heat acts by softening the tissues and 
hastening the carrying away of the products of 
inflammation, thus decreasing the pressure on the 
nerve ends in the inflamed area. Cold acts by 
contracting the dilated blood capillaries and thus 
decreasing tension. Wet dressings and ointments 
act by softening the tissues and frequently con- 
tain some agent to rid the inflamed area of the 
specific cause of inflammation — some micro- 
organism, for instance. 

Abscess Formation 

An abscess is a localized area of infective in- 
flammation containing live and dead microorgan- 
isms, live and dead phagocytes (white blood cells 
which have been combating the microorganisms) , 
fluids forced out from the blood capillaries, and 
the broken-down products of dead tissue cells. 
The content of an abscess is called pus. 

The treatment of an abscess is in accordance 
with the rules for treating other inflammations, 
but with the added rule that the pus when formed 
must be evacuated. Abscesses should be incised 
and drainage instituted in order to reduce the 
pressure on the tissues. The tissues must be rid- 
ded of the irritating products of infective inflam- 
mation, and the chances of the infecting organism 
gaining access to the general circulation and 
causing further trouble must be lessened. 

Strict care must be taken not to introduce fur- 



FIRST AID AND EMERGENCY PROCEDURES 



63 



ther infective organisms when the incision is 
made; thai is, an aseptic technique must be em- 
ployed. The incision musi large enough to allow 
good drainage. 

Never squeeze an abscess as this tends to break 
down Nature's barrier and to spread the ini 
lion. The amount of tissue thai may die is de- 
pendent upon the severity of the inflammation; 
this dead tissue is spoken of as slough. When the 
slough include- the skin or mucous membrane, 
an ulcer results. 

A boil, or furuncle. i> an abscess in the true 
skin in which the infecting microorganism gener- 
ally gains access by way of a sebaceous or a -went 
gland, and in which there is a small slough in or 
beneath the tine skin. A boil at the end of the 
nose or within the nostrils is very dangerous be- 
cause, as a result of handling, incision, or other 
trauma, the infection enters the blood and i< very 
easily carried by the veins to the large venous 

channels on each side of the sphenoid bone (the 

cavernous sinuses | and thence spreads to the brain 

to form abscesses, or tbe meninges to cause men- 
ingitis, or into the general circulation to resull 
in septicemia and possible death. 

A carbuncle is a boil or furuncle in which there 
are multiple sloughs often coalescing in one 
beneath the true skin. When the pus from these 
sloughs finds its way to the surface an opening 
occurs, hence tbe numerous foci of pointing 
called "coming to a bead." Carbuncles, when- 
ever the\ aic located, are very dangerous; those 
about tbe face are especially so on account of the 
ease with which infection can be carried to the 
cavernous >inu>es and thence to other parts of the 
body as explained in tbe preceding paragraph. 
A patient suffering from one should be brought 
immediately under the care of a medical officer. 
If a furuncle breaks, one opening re-ults: if a 
carbuncle breaks, numerous openings result. Dia- 
betes, Bright's disease, and condition- of lowered 
resistance brought about by living in impure air, 
on improper foods, etc.. render an individual 
particularly susceptible to boils. 

Boils and carbuncles should be treated by : 

1. Placing the site of the furuncle or carbuncle 
at rest. 

•2. Putting tbe patient to bed is advisable. 

3. X-ray therapy is the ideal treatment when 



the boil or carbuncle is in the indurated 

t hat i-. before it ha- come to a head. 

If X-ray therapy la not available the treatment 
should be: 

1. Resl and avoidance of trauma. 

-. Application of heat \<\ hot wet die-- 

Relief of pain (aspirin or codeine mat be 
given ). 

I. Ample fluid intake ami high-caloric diet. 

When there is definite fluctuation make a 
-mall incision to evacuate the pus. When there 
l- a medical officer present and in the absent 
X i a\ facilities, early, radical, and complete 

ion is curat i\ e. 
A boil or infected hair follicle at the end of the 

nose or inside the nostril i- in one of the -i dan 

gerous area- for infections to develop. Tin 
i- known a- the dangerous triangle. See illus- 
tration. A patient with an infection in tin 
should be brought under the care of a medical 

officer a- -oon a- possible. If a medical officer i- 

available within a few hour-, leave the patient 
Si rift ly alone. 

1. Place at rest 

■_'. [f several hours or more maj elapse, t he hos- 
pital corpsman may apply hot, wet saline compacts 

for fifteen minutes every two ho 
:'). Administer 300,000 unit- of penicillin. 

I. Place under the care of a medical offio 

soon a- possible. 

Inflammation or infection in outlined area is 
part icularl) dangerous 




Figure 52. — The Dangerous Triangle. 



64 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



WOUNDS 

A wound is defined as the forcible solution of 
continuity of any of the tissues of the body. The 
principal types of wounds are clean or aseptic 
wounds, infected, or septic wounds, and poisoned 
wounds. A clean or aseptic wound is one to which 
no germs have gained access ; the best example of 
it is a wound made by the surgeon's knife. An 
infected or septic wound is one in which there have 
been introduced pus-producing organisms or such 
organisms as produce tetanus or lockjaw, gas gan- 
grene, or hydrophobia. A poisoned wound is one 
in which some nonliving poison, as distinguished 
from bacteria or microorganisms, has been intro- 
duced by the agent causing the wound ; e. g., bites 
of insects, scorpions, snakes, etc. 

Kinds of Wounds 

An incised wound is one made by a sharp cut- 
ting instrument: this is the class of wounds com- 
monly known as cuts. 

A lacerated wound is the result of the tearing 
of the skin and underlying tissues by blunt instru- 
ments or machinery and presents ragged edges, 
which do not retract much and which, as a rule, 
consist of masses of torn tissues, frequently with 
dirt ground into them. 

A contused wound is one in which the division 
of tissue is accompanied by more or less severe 
crushing. 

A punctured wound is deep and narrow ; e. g., 
stabs are punctured wounds. 

Crushed wounds are more serious than they 
first appear, due to the fact that the dead tissues 
are an excellent culture medium for the growth of 
microorganisms of infective inflammation, result- 
ing sometimes not only in loss of the part, but also 
in general infection of the body; that is, septi- 
cemia, or blood poisoning. 

Gunshot wound is any wound inflicted by the 
missile of a weapon of warfare, such as riflles, 
pistols, cannon, etc. 

When the skin and underlying tissues are 
divided, blood vessels, generally capillaries, also 
are divided, and there is more or less bleeding from 
the cut surfaces of the tissues with a clot forming 
between the cut surfaces. Young connective- 
tissue cells and capillary buds grow into this clot 



from the edges of the wound, replacing the blood 
elements. These young connective-tissue cells and 
the young capillaries form what is known as gran- 
ulation tissue or "proud flesh." Later, the young 
connective-tissue cells and capillary buds develop 
into the mature connective tissue, and the epithe- 
lium of the skin grows over it from the edges of the 
wound. When the cut surfaces are so close 
together that there is very little granulation tissue 
required to heal the wound, healing is said to be 
by first intention. 

When the wound is gaping and considerable 
granulation tissue is required, healing is said to be 
by second intention. Pus infection causes gaping 
of wounds; therefore in wounds infected with pus 
bacteria, healing is by second intention. Connec- 
tive tissue filling in a gaping wound forms the so- 
called "scar/' 

Unless cut ends of tendons are brought together, 
the two ends will be so retracted and there will be 
so much connective tissue formed between them in 
the healing of the wound, that the function of the 
tendon will be lost. Unless the cut ends of a nerve 
trunk are brought together, the function of that 
nerve will be lost forever. Nerve fibrils making 
up a nerve trunk regenerate centrif ugally ; and if 
the pathway for this regeneration is blocked by a 
wall of connective tissue, these fibrils can never 
reach the part that they are supposed to innervate. 

The local factors preventing and delaying the 
healing of wounds are : 

1. Infection with pus bacteria. 

2. The presence in the wound of foreign bodies, 
such as dirt or bits of clothing. 

3. A lowered vitality of the edges of the wound 
due to crushing and tearing of the tissues. 

General and constitutional factors also prevent 
and delay healing; among these factors are poor 
circulation of blood, diabetes, nephritis, and 
syphilis. 






t 




CONTUSED INCISED PUNCTURED LACERATED 

Figure 53. — Kinds of Wounds. 



FIRST AID AND EMERGENCY PROCEDURES 



65 



Treatment of Wounds 

1. Stop hemorrhage and treat shock. 

2. Handle the wound so a- not to introduce 
fresh bacteria of infect ion. 

:'.. Remove foreign bodies, such as dirt, bit 
clothing, etc., from the wound. 

4. If infective bacteria already have been in- 
troduced into the wound, take measure to elimi- 
nate them or prevent their development. 

5. If the wound is an aseptic one. bring the 
edges together so that it can heal by first intention; 
if the wound is an infected one. keep the wound 
open mid furnish drainage; if the wound is a 
poisoned one, neutralize the poison in it and pre- 
vent its entrance into the general circulation. 

C. Treat any constitutional condition which 
may delay or prevent healing. 

Bacteria Causing Infection 

There are two types of bacteria commonly caus- 
ing infection in wounds — aerobic and anaerobic. 
The former are bacteria that live and multiply in 
the presence of air. while the latter are bacteria 
that live and multiply in the absence of air. The 
principal bacteria which cause infective inflamma- 
tion and septicemia or blood poisoning are strep- 
tococci, some varieties of which are hemolytic 
(destroy red blood cell-), staphylococci Pseudo- 
monas aeruginosa {Bacillus pyocyaneus), fre- 
quently called the bacillus of green or blue pus; 
these are aerobic. There are several anaerobic 
bacteria which are frequently present in wounds. 
They commonly inhabit the intestinal tracts of 
man and other animals and are often found in 
soils which have been fertilized with animal ma- 
nure. Anion*; those occurring in wounds, espe- 
cially in war wounds, are the Clostridium welchii, 
commonly termed the <ras bacillus and causing gas 
gangrene, the Clostridium sporogenes, the Clos- 
tridium oedi iiniti, us. and the Clostridium histO- 
lyticum. The Clostridium tetani, or tetanus 
bacillus, is common in the feces of horses and 
cattle, consequently it is found with great fre- 
quency in soils fertilized with manure from those 
animals. It is often associated with Clostridium 
welchii in wounds and it produces a toxin which is 
one of the most powerful poisons known, being 
said to be -JO times as poisonous as dried cobra 
venom. The filtrable virus causing rabies, often 



termed hydrophobia (fear of water which i 
common Bymptom of the diet ierhape 

anaerobic in character. 

Inasmuch as the bacteria of pus infection are 
present everywhere, any wound is likely to be 
infected with them. However, contused and 

crated wounds are most likely to sutler from 11 ' 

tive inflammation, owing to the lowered vitality 
of the tissues. The bacteria of tetanus or lockjaw 
and of gas gangrene are found in except ional num- 
bers in the intestinal content- of herbivorous 

animal-, -uch as horses and cattle, and. for that 

reason, wound-, inflicted by objects which have 

been colli am i nated by manure or by hcavil\ I 

idized -oil are most liable to have introduced into 

them the bacteria of these di-ea-e-. 

In badly lacerated wounds and in punctured 

wound- there i- great likelihood of absence of air 
due to the flapping back of the torn tissues after 
infliction of the wound, and for this reason thi 

type- of wound- afford a very favorite environ- 
ment for the development of tetanus or gas gan- 
grene. Tetanus, or lockjaw, frequently occurs 

a tier stepping on a nail near a barn or -table, the 
nail previously having become infected with 
Clostridium tetani from the excretions of hoi 

or cattle. The vim- rabies is found in the saliva 
of a rabid animal and is introduced by its bite. 

These bites are either lacerated or punctured 

wound-, with their associated anaerobic con- 
dit ions. 

Types of Dressings 

A wound dressing consists of everything \\-r^\ 
to cover or dress a wound. The pad which i- put 
directly over the wound i- called a coinpie— . In 

ordinary emergency treatment a wound dressing 
consists of a compress with bandage to hold it on. 

A dressinj_ r may he either dry or wet. aseptic or 

ant iseptic. 
An aseptic dressing i- one which is sterile : that 

i-. one with no bacteria in it. 

An antiseptic dressing is one w Inch, in addition 
to being sterile, contains some substance for killing 

bacteria. 

A wet dressing generally i- an antiseptic 
dressing. A wet antiseptic dressing generally 

used in wound.- where infective intlanunat ioi 
going on. 

A dry sterile dressing is used to cover a recent 



66 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



"wound which is considered to be free from in- 
fection. The purpose of a wound dressing is to 
stop hemorrhage, to prevent introduction of bac- 
teria, and to prevent further injury to the wound. 

The Navy supplies a first-aid packet which is 
a hermetically sealed tin can containing a dry 
sterile dressing. This is excellent for a small 
wound. The directions for its use are contained 
in the packet. For large wounds, sick bays 
aboard ship are furnished with large and small 
shell-wound dressings. All these dressings con- 
sist of a sterile gauze compress with bandage at- 
tached. Any piece of cloth, such as gauze, cotton, 
linen, muslin, or a handkerchief, is suitable for 
a compress in case of emergency, provided it is 
rendered sterile; and anything that can be used 
for bandaging is suitable as a bandage. The most 
vital point about material used as the compress of 
a wound dressing is that, before it is applied to 
a wound, it should be rendered sterile. 

The part of the dressing which is to come in 
contact with the wound must be kept absolutely 
sterile; i. e., it must not be touched with any part 
of the body or anything else except sterile instru- 
ments before its application to the wound. In an 
emergency, material to be used in a wound dress- 
ing may be sterilized by boiling it 10 minutes. 

First-aid Treatment of Wounds 

1. Stop the hemorrhage. 

2. Treat the shock. 

3. Apply a sterile dressing to the wound. 

4. If a surgeon is not available, the wound must 
be further treated as prescribed hereafter. 

* 
In Treating a Fresh Wound 

1. Cleanse your hands as thoroughly as possible 
by a thorough scrubbing with soap and hot water. 

2. Dip your hands in 70-percent alcohol. 

3. Sterilize all instruments to be used in re- 
moving foreign bodies, such as dirt, glass, splin- 
ters, etc., or for shaving the skin about the wound. 

4. If there is much bleeding, arrest the 
hemorrhage. 

5. If there is much hair about the part, remove 
it by cutting or shaving for a distance of several 
inches from the cut edges. 

6. If there is much grease in and about the 
wound, remove it with turpentine or gasoline. 
Remove all foreign particles with sterile forceps. 



7. Clean the skin about the wound with a sterile, 
clamp cloth; while doing this, protect the wound 
with a piece of sterile gauze. 

8. Dry the wound and skin about it with sterile 
dry cloth or cotton. 

9. Apply tincture of merthiolate to all parts of 
the wound and to the skin about the wound for a 
distance of about one-half inch beyond the wound 
edges. 

10. After the skin has been well dried, the 
wound edges are brought together and a dry 
dressing is applied. 

Attempts to bring the wound edges together 
should not be made when the patient can be 
brought under the care of a surgeon in the very 
near future; but if hours or days must elapse be- 
fore the service of a medical officer can be obtained, 
coaptation should be clone in cases requiring it. 
The edges of a wound should not be brought to- 
gether before foreign bodies and dirt have been 
removed and wound edges have been cleaned. 
"Wounds in which infective inflammation is going 
on should be left open and allowed to drain. The 
two methods by which coaptation may be accom- 
plished are by means of sutures and by means of 
adhesive strings. The former is preferable, as by 
the latter method bacteria of infective inflamma- 
tion most probably will be introduced. 

As a rule, the edges of large, deep wounds should 
not be too tightly apposed. Some chance of es- 
cape should be left for the serum and blood which 
are sure to be present ; that is, means of drainage 
should be supplied. This may be done by the use 
of small pieces of sterile rubber tubing, strands 
of catgut or silkworm gut, or a- narrow strip of 
gauze which has been sterilized by boiling. These 
drains should be placed in the lower angle of the 
wound. Wounds which are dirty and look bad 
should be left open. 

The materials ordinarily used for sutures are 
plain catgut, chromicized catgut, kangaroo ten- 
don, silkworm gut, silk, or linen ; sometimes horse- 
hair is used. Suture material, also called liga- 
tures, is divided into absorbable and nonabsorb- 
able ligatures. Absorbable ligatures are those 
which can be left in a wound, inasmuch as the tis- 
sues absorb them ; included in this class are catgut 
and kangaroo tendon. Silkworm gut, silk, linen, 
and horsehair are nonabsorbable ligatures and 
must be removed after 6 or 7 days. 



FIRST AID AND EMERGENCY PROCEDURES 



67 



Chromicized catgul is catgul which ha- been 
ao treated thai ii will not be so quickly absorbed 
as plain catgut. Catgut is the ligature to !»<• pre- 
ferred in tlic suturing of wounds. Needles used 
in the suturing of wounds are curved, straight, 

round, or cutting one-. 

Where the skin musl be pierced, the curved cut- 
ting needle is preferable. The main point about 
all suture material to be used in a wound i- that it 
musl be sterile. In case of emergency, an ordi- 
nary sewing needle with cotton or silk thread. 
well sterilized by boiling, may be used. This 
sut ure is nonabsorbable and musl I e removed a fter 
(> or 7 days. With the operator's hands and also 

the wound well clean>ed. the needle, threaded 

with the suture, is passed through the skin about 
one-eighth of an inch from the cut edge and on 
past the opposite side at a corresponding point. 
The suture then is tied and the ends cut, leaving 
about one-quarter of an inch remaining; care 
should be taken in tying the suture to use but little 
tension, sullieient only to bring the cut edges in 
accurate approximation. The remaining stitches 
are inserted in the same manner at a distance of 
one-quarter to one-half of an inch apart until 
the wound is closed. When a tendon or large 
nerve has been rut. the ends must be brought to 
gether and sutured with catgut before the wound 
is elosed. Suturing of tendons and ner\c- should 

I e done by medical officers. 

Treatment of an Infected Wound 
1. Elevate the part. 

•_'. Put it at rest. 

•*'>. Remove foreign bodies, if present. 

I. Remove enough sutures, if present, to obtain 
•rood drainage. 

.'>. Insert drain. 

tl. Apply a wet antiseptic dressing. 

7. Treat the constitutional symptoms. 

One of the measures taken in a fresh wound 
suspected of being infected with tetanus or gas 
gangrene is to clean and treat the wound and 
keep it freely open for a time in order that 
anaerobic conditions may not exist for growth of 
these bacteria. As a further precautionary meas- 
ure, tetanus antitoxin is given. A punctured 
wound suspected of being infected is frequently 
cauterized and a dry dressing applied. 






Figure 54. — Some Typei of Needle* U»ed in Suturing. 




Figure 55. — Technique of Closing a Wound. 

CHEST WOUNDS 
tuse of the peculiar physiology of the respi- 
ratory mechanism, wounds of the chest an 
tremely important. From the chapter on anatomy 
and physiology, it i- learned that the luni_ r ~ are 

covered with a membrane called visceral pleura: 

this also extend- oxer ami COVers the inner side of 

the chest wall, and thus it form- a cavity between 

the lung and chest wall called the pleural cavity. 
The pleura i- a smooth, moist, glistening mem- 
brane which allow- the Iiiiil' to expand and move 
freely over the inner surface of the chest wall. 



68 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 56. — Butter-Fly Adhesive Strap. 

The lungs are an elastic substance. The inside of 
the chest is a closed cavity ; by means of contrac- 
tion of the diaphragm and the intercostal muscles, 
the inside of the chest cavity is increased, causing 
a negative pressure or suction of the chest. Being 
an elastic, expansible substance, the lungs allow 
air to come down the trachea (windpipe) into the 
bronchi and fill the lungs; this is called in- 
spiration. 

In wounds of the chest a hole is made in the 
chest wall. This may penetrate just the parietal 
pleura or it may enter the lung substance. Pen- 
etration of the chest wall or the pleura will cause 
a pneumothorax (air in the pleural space). A 
hole in the chest wall allows air to enter the pleural 
space and, therefore, no negative pressure can be 
built up; as a result the lung collapses. This is 
treated by making the dressing and bandage over 
the chest wound airtight. The air that seeped into 
the pleural cavity is slowly absorbed and intra- 
pleural negative pressure is again restored and the 
lung slowly re-expands. When the lung is pene- 
trated the air escapes from the alveoli (air sacs) 
and causes a pneumothorax. Because of the elas- 
ticity of the lung the hole closes on expiration and 
no air escapes if the chest wall is intact. This 
causes what is known as a tension pneumothorax 
which is very difficult to treat without medical 
attention; consequently a medical officer should 



be summoned at once. In instances where blood 
vessels are ruptured blood may collect in the 
pleural cavity; this is known as hemathorax. 
Where the rupture of a vessel occurs in the lung, 
the patient may cough up blood; this is known 
as hemoptysis. 

Treatment of Chest Wounds 

The treatment of chest wounds is as follows : 

1. Decrease respiratory embarrassment; 

make the wound of the chest airtight and admin- 
ister oxygen if available. 

2. Prevent infection, give penicillin when it is 
available, and clean the wound and apply a sterile 
dressing. 

3. Alleviate pain. — Give morphine where there 
is no evidence of head injury. 




AIRTIGHT 
PRESSURE BANDAGE 



Figure 57. — Collapsed Lung Following Chest Wound and Applica- 
tion of Airtight Pressure Dressing. 



FIRST AID AND EMERGENCY PROCEDURES 



69 



I. In the presence of hemoptysis prevent the 
patient from coughing, as this may dislodge the 

blood clot that forms. Administration of 1 

phine will help to prevent coughing. Swallowing 
cracked ice also helps. 

5. Treat shock it' present 

Abdominal Wounds 

Wounds and injuries of the abdomen an- impor- 
tant because of the intra-abdominal organs, 
Simple wound- of the abdomen are relatively un- 
important and are treated a- ordinal*} wound-. 
Wounds of the abdomen do. however, become 
of serious importance when they penetrate the 
abdomen into the peritoneal cavity. Pathogenic 
organisms gain ent ranee into t he peritoneal cavity 
and set up peritonitis. They are also important 
from the standpoint that if the wound is extensive 
enough, the contents of the abdomen will protrude ; 
this is known as evisceral ion. 

More important, however, is the rupture of the 

bowel, which allow- the inte-tinal content- to 
spill out into the peritoneal cavity and cause both a 
chemical peritonitis due to the digestive juices 
and a bacterial peritonitis due to the colon bacillus 
that normally inhabit t he lower part of the gastro- 
intestinal tract. The diagnosis of perforation of 
the bowel i- not difficult to make if the patient 
is wounded by a flying missile or stabbed with a 
sharp object : however, it becomes much more of a 



Sterile moist dressing 




Figure 58. — Abdominal Wound with Protrusion of Intestine. 
211888' 59 — 6 



difficult problem w hen the patient is Struck a bio* 

in the abdomen without actually causing i wound 
in the abdominal wall. The bowel maj either be 
lacerated by compression against theantei ioi spine 

<ir by con i pre-- ion of air in the bowel which call 

the bowel to burst 

Symptoms and Signs 

1. Pain is the first thing the patient usually 
complains of. The pain is usually an excruciat 
ing type of pain that i- generalized over the 
abdomen. 

2. Nausea and vomiting usually accompany 
the pain: however, they may follow it. The 
nausea ami vomiting are due to reverse peristalsis 
-et up by irritation of the bowel due to trauma. 

:;. Tenderness i- always present The tender- 
ness can lie elicited b\ placing the llal hand on 

tin' abdomen and causing firm but gentle pressure. 
Rebound tenderness can be elicited bj suddenly 
releasing the firm pressure on the abdomen. 
This is usually due to a peritonitis being present 
i. Abdominal rigidity is due to spasm of the 

abdominal mii-ch- which i- Nature's way of splint- 
ing the abdomen in order not to «au-e further 
pain. One may al-o see that the patient will 
draw ii]) hi- knees in order to relieve the -p:i- 

muscles. 

5. Shock will be present if the pain i- intoler- 
able, and if there i- a great loSS of blood either 

(\tra- or intraperitoneally. S ><•. overwhelm- 
ing infection may al-o cause shock. The pul-e 
will be rapid and weak. The blood pre— ure will 
be low. 

Treatment of Abdominal Wounds 

It i- imperative that abdominal. ■ he-t. and head 

injuries gel first ] >i i«un \ in transportation to a 
hospital where the\ ma\ receive surgical inter- 
vention of their injuries. The-.- types of injui 

should not be given any more treatment than the 
essential first aid that i- necessary. It i- al-o 
imperative that these patient- be taken to the 

hospital at once if they are expected to b< 

a fair chance of survival. First aid of abdominal 

injuries i- to: 

l. Relieve the pain unless a medical officer will 
be available in a short time. Qiving Opiates may 
make a diagnosis rather difficult for the physician 
and tin' patient ma\ be treated erroneously. If 



70 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



the patient is to be transported, then one-fourth 
grain of morphine will support the patient for a 
few hours. 

2. Treat the wound. — If it is a simple wound, 
treat it as described above. If an evisceration 
exists, the bowel should be covered with a normal 
saline soaked sterile gauze dressing and a scultetus 
binder applied. Do not attempt to manipulate 
or replace the bowel in any manner. This should 
be left up to the surgeon. To expedite transpor- 
tation is the most important thing you can do. 
(See fig. 58.) 

3. Prevent further infection by giving penicil- 
lin and streptomycin if available. Avoid giving 
anything by mouth because this will cause more 
intestinal juices to spill out into the peritoneal 
cavity, thus causing more pain and damage. The 
purpose for this is to splint the bowel as much as 
possible so that it may be put at rest. Gas bacil- 
lus and tetanus antitoxin should always be given. 

4. Treat the shock if present. 

5. For a simple method of holding dressing in 
place see Montgomery dressing under nursing 
procedures. 

Burns 

There are numerous causes of burns but gen- 
erally they may be divided into two groups: 
Thermal and chemical. Thermal burns are those 
due to heat produced by fire, hot liquids, steam, 
explosion and combustion of gases, overexposure 
to the sun, and electrical burns. Chemical burns 
are those due to the reaction of strong chemicals 
(acids and alkalies) to the skin. 

Burns are classified according to the degree of 
depth of the burn. 

1. First-degree burns. — Those in which there 
is only an erythema or redness of the skin. 

2. Second-degree burns. — Those in which 
blisters form. However, none of the secondary 
skin structure, hair, sweat glands, or oil glands are 
destroyed permanently. 

3. Third-degree burns. — Those in which the 
skin is burned black and all secondary skin struc- 
tures are permanently destroyed. 

Treatment of Burns 

The main principles involved in the emergency 
first-aid treatment of burns are : 
1. Relieve the pain. 



2. Prevent shock from existing. 

3. Prevent infection of the burn. 

4. Make the patient as comfortable as possible. 
As soon as the extent of the burn and other 

injuries are determined, the patient should be 
given some medication to relieve the pain. In 
mild cases, y 2 to 1 grain of codeine given orally 
will suffice; however, if the burns are severe the 
patient should be given morphine hypodermically. 
As much as 14 to y 2 grain can be given without 
due concern. It must be remembered, that in the 
first aid treatment of burns, other conditions may 
exist which may need attention also, such as frac- 
tures and head injuries. If a head injury does 
exist, do not give opiates. 

The next most important thing to do is to treat 
the shock. This has already been done to some 
extent by relieving the pain. It has been ob- 
served, however, during the past 20 years, that 
patients who experience severe burns lose great 
amounts of protein due to a secretion of the pa- 
tient's serum through the burned areas. This 
hypoproteinemia can be somewhat controlled by 
the administration of plasma or more preferably 
whole blood if it is available. Usually in an 
emergency, whole blood is not available while 
jdasma is, in most instances, present in a first-aid 
kit. 

It should be remembered, however, that usually 
the burned areas are already sterile from the heat 
that caused the burn ; therefore the less the person 
administering first aid interferes with the burned 
area, the better chance the patient has of not 
becoming infected. 

If the services of a medical . officer cannot be 
obtained in a short period of time, then the corps- 
man should proceed to dress the burned areas. 
This is done in the following manner: 

1. Without attempting to break the skin and 
using sterile technique, remove all clothing and 
charred materials from the burned area. If blis- 
ters are present, do not break them. 

2. Apply very thin pieces of sterile vaseline 
gauze directly over the burned area. 

3. Apply cotton wadding, gauze fluffs, or sterile 
mechanics waste next to the vaseline gauze so as 
to make the dressing bulky. 

4. Following this, apply elastic bandages snugly 
to make a "pressure" dressing. 

If penicillin is obtainable, the patient should be 



FIRST AID AND EMERGENCY PROCEDURES 



71 




Figure 59. — Types and Degree* of Burns. 



72 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



immediately given 300,000 units of procaine peni- 
cillin intramuscularly as a prophylactic measure 
against infection. No further definitive steps 
should be undertaken by the corpsman in the treat- 
ment of burns. Having completed all the above 
and having made sure that no medical officer is 
available, the corpsman should make the necessary 
arrangements to have the patient transferred to a 
hospital at once. 




Figure 60. — Pressure Dressing for Burns. 

Poisonous Snakes 

Poisonous snakes are classified into viperine 
snakes and colubrine snakes. To the viperine 
family belong the rattlesnake, the copperhead, the 
water moccasin, and the viper; to the colubrine 
family belong the cobra and the coral snake. 

In poisonous snakes the teeth are arranged in 
two rows, with a fang on each side ; the fangs are 
outside the teeth and near the point of the jaw. 

Nonpoisonous snakes have four rows of teeth 
without fangs. The imprint of the wound often 
will tell whether a person has been bitten by a 
poisonous or a nonpoisonous snake. The venom of 
different poisonous snakes differs in its action. 
The poisonous constituents are neurotoxin, a 
nerve poison, and hemorrhagin, which injures the 
lining of the blood vessels so that there is an escape 
of blood into the surrounding tissues ; a third con- 
stituent is hemolysin, which destroys red blood 
cells. 

The venom of colubrine snakes is made up prin- 
cipally of neurotoxin and that of viperine snakes 
is made up of hemorrhagin. In colubrine poison- 
ing, the local symptoms are not marked, though 
there are at times severe pain and some tenderness, 
swelling, and discoloration at the site of the bite. 
In 1V 2 to 2i/o hours the patient begins to feel tired 



and drowsy, there often begins some nausea and 
vomiting, and paralysis sets in. generally affecting 
the extremities first and then becoming more gen- 
eralized. This -paralysis finally affects respira- 
tion, so that the patient's breathing becomes slow 
and shallow and finally ceases. Convulsions also 
may be present. 

In viperine poisoning there is pain at the seat 
of the bite, which soon becomes excruciating, with 
rapid swelling and discoloration; there is at the 
same time a feeling of nausea, faintness, and a 
sense of depression ; the pulse becomes rapid and 
feeble and the breathing is labored. 

In fatal cases, death may occur in 24 to 48 
hours. The severity of the symptoms and final 
outcome depend upon the amount of venom in- 
jected and absorbed into the general circulation, 
which, in a large measure, depends on the size of 
the snake. 

Treatment of Snake Bites 

Prompt action is imperative because removal 
of the venom is more difficult, or even impossible, 
after it is absorbed. Make the patient lie down 
and keep quiet. Muscular effort only spreads the 
poison. Tie a constricting band firmly around the 
limb just above the bite in order to restrict the 
spread of the poison and make the veins stand 
out on the surface. This band may be a handker- 
chief j necktie, shoestring, or bandage. It should 
be tight enough to prevent the return flow of 
blood and lymph in the surface vessels, but not 
tight enough to affect the deeper arteries and veins. 

A twist is not necessary because this is not a 
tourniquet. Too much deep pressure is danger- 
ous; it tends to increase the sloughing caused by 
the venom. If swelling causes too much constric- 
tion, the band must be loosened a little ; and as the 
swelling progresses beyond the band, it should 
be moved up the limb whenever necessary. 

1. Apply the constricting band. 

2. Sterilize a sharp knife or razor blade with a 
match flame, iodine, or alcohol. 

3. Make a cross-cut incision through each fang 
mark. These cuts should be about one-fourth inch 
long; when the marks are close together, two cross 
cuts will serve to connect them. Be careful to 
avoid large veins and arteries near the surface 
and other delicate structures, such as nerves and 
tendons. 



FIRST AID AND EMERGENCY PROCEDURES 



73 




Figure 61. — Proper Method of Treatment for Snake Bite. 

The cuts must be made down through the -kin 
so that the poison can be sucked <>ut. Since the 
skin is variable in thickness, the cut may have to 
be one-fourth inch or more deep to gel into the 
soft tissues beneath the surface where the poison 
has been injected. In the WTlSl and in other places 
where many important structures lie near the -ur- 
face, be careful to cut only through the skin BO 
that you avoid cutting tendons and blood vessels. 

4. Apply suction immediately and keep it up 
until the physician arrive-. You can apply it 
with any of the various suction cup- or syringes 
found in the snake-bite kits. Those which create 
and maintain suction by a spring plunger or rub- 
ber hull) are more elleet ive than the hand-operated 

syringe because several of them can he used at 
close intervals when necessary. Suction by mouth 
is also possible hul the lip and cheek muscles 
soon tire: therefore mechanical -net ion devices 
are better because suction may have to he con- 
tinued for several hour-. Bui mouth suction will 
be needed until a mechanical device can he ob- 
tained. If no such device is available, take n 
bottle or a small-mouthed jar and heat it in hot 
water or hum paper or cotton inside it: then 
apply the mouth of the bottle immediately over 
the cross-cut. Suction is created as the bottle 
cools. 

Without adequate treatment, ahout L5 percent 
of the people with snake bite die. Children, who 
are more likely to he bitten than adults, need 
medical attention as promptly as possible because 
the danger is increased by the relative size of the 
victim and the do-e. 

As the poison spreads through the surrounding 
ti>Mies. the swelling also increases. When the 
swelling has spread ahout o inches above the bite, 



an additional ring of CTOSS-CUi incisions ahout '1 

inches from the bite and - inches from e u :i other 

Can he made toward the hod V . Other SUi 

cut- should he made a- the swelling prog 

The constricting band is moved up the limb to keep 

ahead of t he swelling. 

Apply Miction to each of thc-c cut- for 15 min- 
ute- in every hour (as long a- the available suc- 
tion cups will permit), and keep the cut- covered 
with wet. lint compresses of strong Epsom -alt 
solution or table sail solution between the periods 
of Buction. A- these cut- me made iu the swollen 
area, m rather clear fluid, slightly blood-tinged, 
will he obtained on suction. Not much blood is 

intended to lie withdrawn. If :i blood vessel l- 

cut, control the bleeding by applying pressure 
with a small compress held ly the fingers; do not 

apply BUCtion to that inci-imi. A- UUMTJ 

or in cut- mav he necessarj in a severe case. Keep 

the limli slightly lower than the re-t of the body 

for best results. 

There are antivenom serums available for the 
treatment of poisoning by snake bite, one which 
neutralizes neurotoxin and another which neu- 
tralize- hemorrhagin. They are injected hypo- 
dermically or intravenously and arc verj effective 

if properly used; that i-. -er to COmbal the 

venom of a colubrine snake must he used against 
that type of Bnake bite, and the specific serum for 



POISONOUS SNAKE 



NOHPOHONOWS SHAKE 





%■!, V„, 





DvmIV*. 



• ; 



Figure 62. — Comparison of Poisonous and Nonpoisonous Snakes. 



74 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



the viperine snake venom must be used to combat 
the toxin of that type of snake in order to get 
results. 

INJURY OF MUSCLES, JOINTS, AND BONES 

A contusion, or a bruise as it is commonly 
termed, is a crushing and tearing of the tissues, 
usually without a break in the skin. It is char- 
acterized by swelling, tenderness, and discolora- 
tion due to the rupture of blood vessels in the 
neighborhood of the injury. At first the discolor- 
ation is red, then blue or black, and finally is 
yellow or green ; when the discoloration is yellow 
or green it is commonly called back and blue spots. 
The change in color is due to the chemical change 
in the coloring matter of the blood hemoglobin. 
The rapidity in the formation of the swelling and 
its size depend on the number and size of the 
blood vessels ruptured. Contusions vary in ex- 
tent from an ordinary black and blue spot to the 
almost complete pulpefaction of a limb with 
laceration of blood vessels and nerves, such as 
sometimes occur in railway or other accidents. 
A black eye is an example of a contusion. 

Slight contusions as a rule require no treat- 
ment. With severe contusions there is more or 
less shock which must be treated. For the con- 
tusion itself, the treatment is to stop the subcu- 
taneous hemorrhage. This can be done by rest 
and elevation of the part and by very hot or cold 
applications; if the injury is in a limb, firm, even 
pressure of a bandage may be effective. Later, 
when the bleeding has ceased, the absorption of 
the extravasated blood may be hastened by hot 
fomentations and massage. In the case of severe 
contusions and in contusions in elderly people, 
hot water is much better than cold, as the latter 
tends to lower the vitality of injured tissue. 

A strain is the overstretching of a muscle or 
tendon with an attendant rupture of the muscle or 
tendon fibers. In severe strains, small blood ves- 
sels are often ruptured, resulting in the escape of 
blood into the muscles in the same way that blood 
escapes beneath the skin in the case of a bruise. 
It is generally the result of violent exertion or 
sudden unexpected movement. The symptoms are 
pain in the affected muscle, stiffness, lameness, 
and more or less swelling. If complete rupture 
occurs, there will be loss of power of the affected 



muscle, and on examination there will be found a 
distinct gap with considerable swelling above it 
due to retraction of the muscle fibers. 

For slight strain, the treatment consists of: 

1. Strapping with adhesive plaster or band- 
aging, which, with rest, gives the most comfort. 

2. After 2 or 3 days, graduated massage may 
be given. 

3. If rupture occurs and if surgical assistance 
is lacking, immobilize the part by splints or band- 
ages and place the part in such a position that 
the muscles are relaxed, thus allowing the torn 
fibers to come together. 

A sprain is an injury to a joint due to wrenching 
or twisting its ligaments and adjacent soft parts. 
There usually are momentary dislocation and au- 
tomatic reduction of the joint affected. There 
also may be injury to cartilages, and even portions 
of bone to which the ligaments are attached may 
be torn away. Accompanying these injuries there 
is more or less escape of blood into the joint itself 
and surrounding tissues, resulting in severe pain 
and marked swelling of the injured part. Later, 
discoloration develops at the site of injury. 
Sprains of the ankle and wrist are the most com- 
mon. Frequently it is difficult to determine 
whether or not a sprain is complicated with frac- 
ture. An X-ray examination is always advisable 
to determine the presence of a fracture in these 
cases. 

Treatment of Sprains 

In the treatment of sprains all severe cases 
should be brought under the care of a medical 
officer, particularly as the condition may be com- 
plicated with fracture. 

1. Elevate the joint and apply very hot or very 
cold water for one-half an hour to an hour to 
stop the subcutaneous hemorrhage. 

2. Then apply a tight bandage and keep the 
joint at rest in order to give the torn ligaments 
and tissues a chance to heal and the effused blood 
to be absorbed. 

3. Treatment of a sprain of the ankle by im- 
mediately strapping the joint and by allowing 
the patient to walk about may be practiced in 
the less severe, uncomplicated cases. For this 
purpose strips of adhesive plaster 1 to iy 2 inches 
wide and about 18 inches long should be obtained. 
A strip is started well behind at the junction of 



FIRST AID AND EMERGENCY PROCEDURES 



75 



the lower and middle third of the leu of the in- 
jured side and is carried down under the heel 
with considerable tension, across the sole, and up 
the other side of the joint. The middle of an- 
other strip is applied to the point of the heel and 
the tWO end- are carried forward o\er the foot. 

hnt not far enough to meet. Leg strips and fool 

strips alternate, interlacing with each other and 
overlapping about one-third of the previous -trip 
each time until the ankle joint is coi ercd. St rap- 
ping in this manner furnishes pressure and at the 

same time fixes the joint and gives Support to 
the torn ligaments. If any individual is unable 
to walk immediately after injury to the ankle, 
the injury should he considered a- a fracture until 
proven otherwise. 





Figure 63. — Method of Strapping Ankle. 

Dislocation 

A dislocat ion i- a slipping away from each other 
of the bones which form a joint, resulting usually 
in a locking of the hone- in a new position. Neces 
sarily the dislocation is attended with tearing of 
the ligaments and often with rupture of the mus- 
cular attachments a- well, except in a joint which, 
on account of frequent prior dislocations, has had 
its ligaments so stretched that not only i- disloca- 
tion easy but no tearing of the ligaments results. 
As a result of the tearing of structure about the 
joint, there is also rupturing of the blood vessels, 
with consequent swelling and discoloration. 

Dislocations must he differentiated from frac- 
tures and sprains. In all three conditions there 
may be swelling and pain in the neighborhood of 
a joint. In fracture there is an unnatural move- 
ment of the bone between tin- joints instead of 
immobility at the joints as in dislocations, and 



the movement i- attended with a gratinp sound 

and Sensation. The deformity i- in the hot 

tweeii the joint- in fracture-, whereas the de- 
formity i- at ( he joint in dislocations. In dis- 
locations there i- immobility at the joint and 
between the joint-, and the head of the dislocated 
bone may be felt in an abnormal position. Iii 
,-prain- there i- absence of any of the symptoms of 
dislocation except swelling and pain. A- a rule 
-pram- are momenta! \ dislocations in which the 
head of the bone ha- slipped hack into place. If 

facilities are available, all • hould be X 

ra\ ed before and a ftei t ical ment. 

Treatment of Dislocations 

The treatment consists in restoring the bones 
to their normal position (spoken of a- "reducing 
the dislocat ion" ) and then in bo confining the parts 

thai a reel I ire i ice of t he t rouble will be improbable. 
The joint -hould be immobilized until tin- rent- in 
the ligament have healed. While Bome di- 
lion- -lip easily back into place, proper reduction 
of the majority requires considerable knowledge, 
-kill, and either local or general anesthesia. With- 
out careful manipulation, blood vessels and nerves 

not only may be injured but :i -imple dislocation 
may become complicated with fracture. In view 
of this, if BUrgical aid can be obtained within a 

day <>r two, do not attempt to reduce a dislocation, 
except perhaps in case of the jaw and finger. 

1. Loo-en the clothing aboin the injure. I part 

and support it a- comfortabl) a- possible iii the 
new position, or if the patient must In- moved, 

Support the bin 1 1 in a sling or by splints and band 
aire- and -umiiion BUrgical a--i-tai 

•J. I f. however, surgical assistance cannot be had 
for BOme time, perhaps for '■'< or 1 day-, careful 
attempt- should he made to reduce the dislocation, 

as the head of the Lou.- concerned most probably 

will become bound by connective ti— ue formation 
ami then reduction will become next to impossible 
without an operation. Shock is often pi 
with major dislo and -hould I*- tie. ited. 

Dislocation of the Jaw 

In this condition the patient cannot speak OT 
close In- jaw-. The dislocation is due generally to 
a blow upon the mouth when open or by yawning 



76 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 64. — Reduction of Dislocated Jaw. 

or laughing. This dislocation usually is reduced 
without much difficulty, but there is great danger 
of the thumbs of the operator being bitten. 

Treatment 

Wrap the thumbs well with a handkerchief or 
bandage, stand in front of the patient, and while 
pressing with the thumbs in the mouth just back 
of the last lower molars, lift up the chin with the 
fingers. The jaw usually will snap at once into 
place, and the thumbs must be quickly withdrawn 
to prevent them from being bitten. After reduc- 
tion no further treatment is indicated, but the 
patient should be advised to open the mouth no 
oftener than necessary. 

Dislocation of the Finger 

The finger joints are the most important joints 
of the upper limb. These joints are particularly 
susceptible to injury and very readily stiffen fol- 
lowing even minor injuries, so that improper 
treatment may result in months of incapacity. 
Every finger injury must be treated with the great- 
est of respect. 

Treatment 

With a dislocated finger joint, pull on the dis- 
located end, at the same time bending it backward 
if the dislocation is forward, or forward if the 




Figure 65. — Treatment of Dislocation of the Finger. 

dislocation is backward, and pushing the joint into 
place ; strap or splint the finger. 

Dislocation of the Shoulder 

In this dislocation the arm is held rigid, the 
elbow stands off at a distance of 3 or 4 inches from 
the body, and the shoulder appears flat with a 
marked depression beneath the point of the shoul- 
der. In addition there is pain and swelling at 
the site of injury, and the head of the humerus 
can be felt in an abnormal position as compared 
with the other side. Do not try to reduce this 




Figure 66. — Dislocation of the Shoulder. 



FIRST AID AND EMERGENCY PROCEDURES 



77 



dislocation if surgical assistance can be bad in a 
few davs: if cot, follow this prescribed treatment. 

Treatment 

Plan' the patient upon his back on the deck or 
table Tin' operator takes off one shoe, inserts 
his heel under the armpil of the dislocated side, 
and makes traction upon the arm downward and 
slightly toward the patient's body. In doing this, 
care must be taken not to employ too great level 
age action upon the arms, as a fracture mighl be 
produced. After reduction, immobilize the joint 
with a Velpeau bandage without the pad in the 
armpit, and keep the arm bandaged for a week. 

If the dislocation fails to lie reduced by these 
methods, do not persist in attempting reduction, 
as ii is a case for operat ive surgery. 

Fractures 

A fracture is a broken hone. It iniiv he partial 
or complete. Tissues near the site of a fracture 
are injured also. If in douht as to whether or not 
a hone is broken, always treat it as a fracture. 

Classifications of Fractures 

1. Simple fracture. — The bone is broken hut 
the surrounding tissues and skin are unbroken. 

2. Compound fracture. — The hone i> broken 
and there i- an open wound in the soft tissues 



leading from the akin surface to thi of the 

fracl 

.".. Greenstick fracture. — The bone shaft is bent 
and cimked liui not complete!} broken through. 

I. Comminuted fracture.— The bone is crushed, 
splintered, or broken into a numbei "i fragi • 

... Imparted fracture. A fragment of bone is 
forcibly driven into another ami remains more oi 
less fixed in thai posit ion. 

An X i >\ examination i- ordinarily the only 
mean- of making an accurate diagnosis, espe 
cially in head injuries, hut the symptoms of pain, 
loss of function, and deformity arc easily recog 
ni/.ed by the corpsman and enable him to determine 
the proper method of treatment and evacuation. 

Concussion and Skull Fracture 

Whether or not the skull i- fractured i- not as 
important a- the possibility of an injury to the 
brain. First aid efforts should not lie concerned 

with whether or not the patient has a fractured 

skull. The primary treatment at tl of 

an accident would Ih' the -ame whether tile >kull i- 

fract ured or not. 

The term concussion i- often used incorrectly to 
describe any or all effects of head injury. Con- 
cussion of the brain i> indicated by a brief period 
of unconsciousness immediately after a head in- 
jury, [f concussion i> prolonged, it may indicate 






•d. 



SIMPLE 



COMPOUND GREENSTICK 

Figure 67. — Types of Frocrures. 



COMMINUTED 



IMPACTED 



78 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



more serious effects on the brain, such as bruising, 
tearing, or hemorrhage. Patients who have been 
unconscious even for a short time should be re- 
garded as having potentially severe head injuries 
and should be kept quiet until examined by a 
physician. 

The symptoms of head injury vary greatly, and 
patients with injuries which appear relatively 
mild at first may later develop symptoms of 
serious effects caused by pressure on the brain 
from swelling with fluid and hemorrhage. 

At the scene of an accident, one can usually 
determine an injury to the head by appearance 
on it of a bump or laceration. The patient may 
be dazed or unconscious. There may be bleeding 
from the ears, nose, or mouth in severe cases. The 
pupils of the eyes may be unequal in size. Partial 
paralysis may result from injury to the head. 

Treatment of Skull Fracture 

1. Keep the patient lying down, with his head 
and shoulders slightly raised if his face is flushed 
red in color. If his face is pale, keep the patient 
level, or lower his head slightly. 

2. Move him only in a horizontal position, 
handling him carefully and avoiding unnecessary 
movements. 

3. Don't give stimulants. 

4. Keep the patient warm, but do not apply 
hot water bottles or other heated objects to the 
unconscious patient. 

5. If hemorrhage is profuse, it may be con- 
trolled by direct pressure. 

6. Get the patient to a hospital as soon as 
possible. 

7. Do not give morphine. 




Fracture of the Nose 

There is usually considerable deformity (the 
bridge of the nose being depressed and pushed 
to one side), crepitus generally can be felt, and 
there is considerable nosebleed. Return the bones 
to their normal position, if possible, by gentle 
manipulation. To hold the bones in position, ap- 
ply two very small rolls of narrow bandage on 
either side of the nose and hold in place with 
short strips of adhesive plaster. Check the 
hemorrhage by syringing the nostrils with hot or 
cold water, or, if necessary, pack the nostrils with 




Figures 68. — Fracture of the Skull. 



Figure 69. — Treatment of Fracture of the Nose. 

cotton. Warn the patient not to blow his nose. 
Have this patient brought under the care of a phy- 
sician as soon as possible. 

Fracture of the Jaw 

A broken jaw can generally be recognized by 
difficulty in talking, eating or swallowing, and 
by pain upon movement of the jaw. Usually the 
patient has suffered a sharp blow to the jaw. The 
teeth are usually out of line. Considerable swell- 
ing may develop later. 

Treatment 

1. Pain may ordinarily be controlled with 
aspirin or codeine. 

2. Ice bags can also be employed to relieve pain 
and keep down swelling. 



FIRST AID AND EMERGENCY PROCEDURES 



79 



8. Hold the jaw iii place and prevent excessive 
movement by applying a I tailed or Barton 
bandage. 

I. Give ilif patient a liquid diet. 

5. Refer the patient to :t medical or dental of 
ficer a- soon as possible. 




Figure 70. — Fracture of the Jaw. 




Figure 71. — Bandage for a Fractured Jaw. 

Fracture of the Neck 

A fracture of the neck is usually caused by a 
rather violent accidenl in which the patient either 
falls on his head or receive.- a severe blow to the 
neck region. If such an accident results in pain, 
inability to move the neck, or an unnatural posi- 
tion of the head, one should suspect a fracture of 
the neck : that is, of the spinal column. It is very 



important that the head be maintained in a 
stationary position during transportation of the 

patient. 

Treatment 

These fractures are immobilized by a high collar 
which tend- to lengthen the neck and raise the chin 
so a- io arch the neck backward. A simple collar 
can he improvised from an artillery -hell con 
tainer. The cardboard cylinder is cut with a 
knife info a collar about •"> inches high. It i- split 

on one side, pulled apart, and placed around tin- 




Figure 72. — Immobilization for Fracture of the Neck. 

neck. Tad well with felt or similar mat 
It is held closed by means of adhesive tap \ 
similar type of splint can be improvised with a 

new-paper or other material. 

Fracture of the Clavicle 

In a fracture of the clavicle the attitude of the 

patient is characteristic; the shoulder drops down- 
ward, inward, and forward, and he attem] 
support it by holding the elbow of the injured 
Bide in the hand of the SOUnd side. Since the 
collar hone lie- immediately under the -kin, the 

fracture i- easily made out from the deformity 
and localized pain ami tenderness. 






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HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 73. — Bandage for Fractured Clavicle. 

Treatment 

1. The figure-of-eight bandage may be used ; it 
holds the shoulders backward and immobilizes the 
fracture. Be sure that it is firmly applied. 

2. First pad the axillae to prevent the bandage 
from cutting. Hold the end of a 3-inch bandage 
on the outside of the shoulder and carry the roller 
diagonally downward across the shoulder blades, 
around the axilla, and over the shoulder of the 
opposite side. Continue downward across the 
shoulder blades to the axilla and up over the 
shoulder to the starting point. Repeat the pro- 
cedure for three additional turns, overlapping the 
preceding turn by one-third its width. Secure 
the ends with a pin or adhesive plaster. 

3. Transport this patient to a medical officer 
at once. 

Fracture of the Humerus 

Fractures of the shaft of the humerus present 
all of the usual signs of a fracture. The arm feels 
wobbly, pain is felt, crepitus is present. Frac- 
tures near the elbow are known as elbow fractures. 
When they occur with the elbow in complete ex- 
tension they are sometimes called extension frac- 
tures. The arm is found in complete extension, 
or nearly so, and should be left that way. Frac- 
tures in this locality are serious from the liability 
of the joint to become stiff, and the patient should 
be brought under the care of the surgeon as soon 
as possible. 

Treatment 

1. A fracture of the neck or upper third of the 
bone may be treated temporarily by placing a pad 



or folded towel in the armpit and securing to the 
side with a bandage, then placing a sling about the 
wrist. With this dressing the weight of the arm 
and forearm acts as an extension. 

2. Fracture in the middle of the shaft of the 
bone may be treated by the use of two broad 
splints, or four narrow ones placed about the 
seat of injury and secured by a bandage or strips 
of adhesive plaster, the wrist being supported by 
a sling. Care must be taken that the splint does 
not extend too high in the armpit, as it might 
compress the blood vessels or at least be exceed- 
ingly painful. 




Figure 74. — Treatment of a Fractured Humerus. 

3. A fracture near the elbow joint may be 
dressed temporarily by applying a large sling and 
securing the arm to the body. 

Fracture of the Bones of the Forearm 

When both bones of the forearm are fractured 
all the usual signs of fracture are present. When 
only one bone is broken, the other acts as a splint 
and but little deformity will be apparent, but there 
is inability to use the forearm; on examination, 
tenderness and a false point of motion can be dis- 
covered at the seat of injury. With a fracture of 
the radius alone — low. down, and just above the 
wrist — there is a well marked deformity, termed 
a silver-fork deformity, which is a symptom of 
the fracture of the radius spoken of as Colles 
fracture. In this fracture the tip (styloid process) 
of the lower end of the ulna is often broken off, 
and there may be rupture of the internal lateral 



FIRST AID AND EMERGENCY PROCEDURES 



81 



ligament of the wrist As the bonee are usually 
impacted, no grating or crepitus is present. 

Treatment 

In treating fractures of the Forearm, one should 
put the limb up with the elbow bent mi n right 
angle, the forearm across the chest, the palm »>f 
the hand turned in, and the thumb pointing 
upward. 

1. First reduce the deformity by gent le i raction 
upon the hand and then apply two well padded 
splints to the seat of the fracture, making sure 




Figure 75. — Colles's Fracture. 

iliat they arc long enough to extend from the el- 
how to below the wrist. 
2. Bandage the splints and support the forearm 

by means of a slim:. 

•">. It is very important that all case- of Colles's 
fracture should lie brought under the care of a 

Surgeon as SOOn as possible, as the deformity is 
apt to he permanent unless the fracture is properly 
reduced and treated. 

Fracture of the Rib 

The symptoms are pain or stitch in the side and 
some difficulty in breathing. Pain may he espe- 
cially severe if the patient coughs or sneezes or 
breathes deeply. The danger in rib fracture i- 
injury to the lung, and with this complication 
there may he spitl ing up of blood and escape of air 
beneath the tissues Of the chest wall, a condition 

called emphysema. On examination by passing 
the fingers along each rib in succession, one will 
he able to find a local point of tenderness and 

often a false point of motion or grating in one or 
more of them. By placing the ear against the in- 
jured side and asking the patient to take a deep 
breath, one may hear grating distinctly. 

Treatment 

In treatment of fractured ribs it is impossible 
to splint only one or two ribs. In order to immo- 



bilize the fracture it i- necessary to immobilize the 
whole side on which the fracture lias occurred. 
This Bplinting can he temporarily accomplished 
with a broad binder of muslin, a triangular band- 
age, or an ordinary roller bandage firmly w rnp|>ed 
around the chest, but the best method is to -trap 
tin- chest with adhesive plaster wide enough to 
cover the injured side, ahout B or :i inches wide 
and long enough to extend from the -pine behind 
to just beyond t he median line in front, and apply 

i- follows: 

1. With the patient Standing with arm- above 
the head, tell lulu to let all hi- hreath out : a- he 
does this, quickly apply the plaster to the injured 

Bide, starting just a little to the other Bide of the 
spine in the hack and bringing the -trap to ju-t 
beyond the middle line in front. 

•_'. The plaster is applied at the end of a forced 
expiration, because at tin- time the broken frag- 
ments are more nearly in apposition. In place 



W- 




Figure 76. — Strapping a Fractured Rib. 

of a single strip of plaster, several -nip-, each 
ahout •_'•- inches wide, may he applied, beginning 
well below the fracture and gradually working 
up. 

:'». Apply each strip with firmness at the end of 
a forced expiration, allowing it to overlap one- 
third of the one below. 

I. When there i- injury to the lungs accom- 
panied by spitting up of blood, keep the patient 
quiet in Ih««I and give cracked ice by mouth. 

' iet tin- pit lent to a phy-icnu )0 a- 

ble. 

Fracture of the Spine 

In fractures of the spine, the spinal cord is 
generally injured or cut across, with resulting 



82 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 






Figure 77. — Proper Position for Transporting a Patient with 
Fractured Spine. 

paralysis to all parts below the fracture. On 
passing the fingers clown the spine, one will note 
irregularity of the spinous processes with deform- 
ity as well as local pain over the site of the 
fracture. 

Treatment 

1. Keep the patient perfectly quiet and lying 
flat on his face until surgical aid can be obtained. 

2. If it is necessary to move him, it should be 
done with extreme care to prevent any additional 
injury to the spinal cord. 

3. Although the desirable position for a frac- 
ture of the spine is on the abdomen, for long trans- 
portation it is more comfortable to the patient to 
lie on his back. When such a patient is found 
lying on his abdomen, enlist the help of several 
assistants and gently roll him onto the board, 
placing plenty of padding under the small of his 
back. The padding keeps the fractured vertebra 
separated and protects the spinal cord from 
injury. 

4. Tie the patient to the board to hold him 
while he is being transported. 



5. Never let a suspected spinal fracture be lifted 
or assume a sitting position. 

6. The most important thing to remember is 
that the sharp bone fragments will cut the spinal 
cord if they are moved. This will result in per- 
manent paralysis of the body and legs. 

Fracture of the Pelvis 

The patient is unable to sit up or stand and 
complains of great pain and a sense of coming 
apart. Crepitus may be felt on strong pressure. 
These fractures generally are accompanied with 
injury to the internal organs and more or less 
shock. With injury to the bladder, blood is passed 
in the urine. 




Figure 78. — Immobilization for Transportation of Fractured Pelvis. 

Treatment 

1. For first aid, move the patient carefully and 
only in a lying position on his back on a rigid 
stretcher, door, or board. 

2. Bandage the knees and ankles together and 
either bend or straighten the knees, depending on 
which position is most comfortable. 

3. The patient's bed should also be fixed so 
that it will not sag under his pelvis and the thighs 
should be supported with pillows. 

4. In case of hemorrhage from the bladder, 
which indicates a rupture of that organ, a catheter 
should be introduced and left in,. so that the urine 
will not accumulate and escape into the peritoneal 
cavity. 

5. A urinary antiseptic, methenamine (uro- 
tropin), should be administered by mouth. 

Fracture of the Femur 

The patient usually lies with the toes of the 
injured limb pointing outward; any attempt to 
move the limb results in a spasm of the muscles 
and causes the patient excruciating pain. There 
is loss of power in the limb ; the patient is unable 
to lift it. On examination, if the fracture is on 
the shaft of the bone, a false point of motion is 
discovered. By measurements the fractured limb 



FIRST AID AND EMERGENCY PROCEDURES 



83 




Figure 79. — Immobilization for Transportation of Fractured Femur. 



is round (o be shorter than the other one, < I u«- to 
the pull of the powerful thigh muscles. 

Treatment 

1. Apply twit splints, one from the outside 
reaching from the armpit to beyond the foot and 

one on the inside from the notch to I he toot. The 

splints should he tied in five place: around the 

ankle, over the knee, just helow the hip, around 
the pelvis, and just helow the axilla. It is well 
to t ie hot h limbs togel her. 

•_'. The patient must he brought under the care 

of a Burgeon as soon as possible, as an anesthetic 
is frequently accessary to effect reduction. 

3. A traction splint or other means of extension 
is generally required. 

I. Do not move these case- without splinting. 

Fracture of the Patella 

This fracture DHty he caused either by a hlow 

or by muscular action. Usually you can feel a 

groove of separation in the kneecap. The usual 
symptoms of fracture are present. 




Figure 80. — Immobilization for Transportation of Fractured Patella. 

Treatment 

1. The two fragments can be brought together 

by strips of adhesive plaster/one strip passing 
above the upper fragment and the other helow 
the lower one. 

ii. In place of adhesive plaster a figure-of-eight 

bandage may be applied. 



■".. The patient should be put to bed with the 
injured leg elevated on a pillow. 

I. Ice -hoiild be applied to the joint with the 

object of limiting and decreasing the swelling. 
For firsl aid, straighten the limb. Use a board 

that will reach from the buttock to the heel ami 
that is at least I inches wide. Pad well \% it 1 1 
extra padding iiiuler the knee and ju-t above the 
heel. Apply one hand strip just above the knee 
and one ju-t helow the knee: and also put one at 

the ankle and our on the thigh. Leave the b 
cap exposed because the swelling may be rapid. 

Fracture of the Lower Leg 

When both hone- of the leg ate broken, the 

usual signs and symptoms of fracture are present. 
These fractures often are compound. If only 

one hone i> broken, the other act. as ;t splint and 

deformity will not he 90 marked, hut there will 

he present a local point of tenderness, swelling, 
and probably discoloration of i he -km. Fracture 

of the lower end of the fibula i- spoken of a- a 

Pott's fracture. Pott's fracture is generally ac- 
companied by tearing of the internal lateral Ligl 
ment of the ankle joint or h\ a fracture of the 
internal malleolus, in which case there i- great 




Figure 81. — Pott'i Fracture and Immobilization for Transportation 



84 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



deformity and turning out (eversion) of the foot. 
In case it is purely a fracture of the lower end of 
the fibula, there may be few of the usual signs 
of fracture and the injury may be mistaken for a 
sprain. 

Treatment 

1. Reduce any deformity by traction in the 
long axis of the limb. 

2. Apply three well-padded splints — two side 
splints and a posterior one. In case of Pott's frac- 
ture do not apply a posterior splint. The latter 
is to give support and prevent a backward sag- 
ging at the seat of the fracture. A pillow and 
two side splints also make an excellent temporary 
dressing. A pillow covered by a pillow case is 
placed upon the deck, and the injured leg is laid 
carefully upon it ; the edges of the pillow are then 
brought around the foot and limb and are pinned 
in place; finally the two side splints are applied 
outside of the pillow and are secured in place by 
straps of adhesive plaster or strips of bandage. 

Splints 

Splints are agents for immobilizing a fractured 
part. There are two general classifications of 
splints, traction splints, and coaptation splints. 

Traction splints are those which, in addition to 
immobilizing a fracture, are constructed in such 
a manner that by their use extension and counter- 
extension can be applied without the use of other 
apparatus for this purpose. 

Coaptation splints are those which are used 
solely to immobilize the fracture. 

Traction splints are indicated in fractures 
where there is much muscle pull tending to dis- 
place the fragments. The most common traction 
splints are the Thomas leg splint and modifica- 
tions of the same, the Jones humerus traction 
splint, the Army hinged half-ring thigh and leg 
splint (Keller), the wire ladder splint, and the 
Cabot posterior wire splint. To obtain extension 
by use of these splints, adhesive strips or tapes are 
fastened to the skin and attached to the distal end 
of the splint, while counterextension is obtained 
by the push of the other end of the splint against 
the body. 

In an emergency any material which has suffi- 
cient firmness to give support to a limb will answer 
for coaptation splints. Examples are: umbrel- 



las, canes, swords, scabbards, guns, cigar boxes, 
wire, leather, laths, tent pins, pillows, or a folded 
coat. In fractures of the thigh and leg, the sound 
limb may be used as a splint. Plaster of paris 
bandage may be used. Adhesive plaster gener- 
ally is used to splint a fractured rib. Any mate- 
rials used for splints must be light but sufficiently 
rigid to prevent bending; long enough to reach 
the joints above and below the fracture; broad 
enough to prevent pinching of the limb in band- 



\ 




^^ 



Figure 82. 



-Thomas Splint for Traction and Type of Coaptation 
Splint. 



aging ; and sufficiently padded to protect the part 
from undue pressure. 

Coaptation splints may be applied temporarily 
over the clothing and should always be well 
padded, as a hard board against an injured limb 
soon becomes very painful. Oakum, cotton, grass, 
moss, portions of clothing, or any soft material 
will answer for the padding. If possible, two 
splints should be applied to a limb, while in frac- 
tures of the leg three generally are used, one on 
each side and one behind. In applying splints, 
have an assistant hold them in position and then 
firmly fasten them to the limb by several turns 



FIRST AID AND EMERGENCY PROCEDURES 



85 



of a roller bandage, adhesive strips, handkerchiefs, 

pieces of rope, or portions of clothing. 
While splints should be applied snugly, care 

should be taken not to apply them too tightly 
for fear of « • u 1 1 i 1 1 ur oil' the blood circulation; 
leave the tips of the fingers and toes exposed and 

watch the circulation. If the tip- of the fingers 
are blue and cold, or if, upon pressing upon the 
nail-, the normal pink color does DOl quicklj re- 
turn, the dressing is too ti<rht. Remember that 
although a splint may he applied with the proper 

degree of snugness, later swelling of the fractured 

limh may cause it to he too tight. The u-e of 
plaster of paris as splinting material should he 
Kd't to the surgeon. 

BANDAGES AND BANDAGING 
Bandages are employed to hold dressings ap- 
plied to the surface of the body, to secure splints 
in the treatment of fractures and dislocation t<> 

create pressure, to immobilize joints, and to cor- 
rect deformity. Various materials are employed 
in making bandages, such as gauze, flannel, crin- 
oline, muslin, linen, rubber, and elastic webbing. 
Gauze frequently is used because it is light, 

soft. thin, porous, readily adjusted and easily 
applied. Flannel, being soft and elastic, may he 
applied smoothly and evenly; and as it ahsorbs 
moisture and maintains body heat, it is wry useful 
for certain conditions. Crinoline, rather than 
gauze, is used in making plaster of paris bandages, 

as t he mesh of the crinoline holds the plaster more 
satisfactorily than <rauze. 

.Mu.-lin is employed in making bandages because 
it is inexpensive and readily obtainable. It 

should be soaked in water to cause shrinkage, 

dried, and finally ironed to remove wrinkle-. A 
large piece of this material may be torn easily into 
Strips of the desired width. Rubber and elastic 
webbing are used to afford firm BUppoii to a part. 
The webbing is preferable to the pure rubber band- 
age, as it permits the evaporation of moisture. 

A hospital corpsman should become familiar 
with the general rides of bandaging and proficient 
in the application of the various types of band- 
ages. The comfort of a patient, the security of 
the dressing, and the professional reputation of 
the hospital corpsman depend on the proper appli- 
cation of a bandage. A neatly and properly 
applied bandage is an indication that the dressing 
211 sec- 58 — 7 



covered by the bandage has been properly per- 
formed. An untidy, uncomfortable, in >- urt 
properly applied bandage maj reasonably lead 

one to BUSped that the underlying' dressing 

the -anic character ami can result only in adverse 
crit icism. 
Various types of commonly used bandages are 

the roller bandage, the triangular bandage, and 

the many tailed bandage. The roller bandage is 
made from one of the aforementioned materials, 
with the width and length depending upon the 
pan to he bandaged. For convenience and ease of 

application, the -trip of material i- rolled into 

the form of a cylinder. Each bandage of thi- 
type should consist of only one piece that i- free 

from Wrinkles, -cam-, selvage, and any impel lec- 
tions thai may cause discomfort to the patient. 

Although there are various type- of mechanical 
appliances used in winding bandages, it i- essen- 
tial that hospital corpsmen should !*■ able t<> i"ll 
a bandage by hand. Thi- i- done in the following 
manner: The -trip- of bandage material should 

he folded at one extremity Several tune- to form 
a -mall, linn cylinder. This cylinder i- held by 
n- eztermities with the index finger and thumb 
of the left hand. The free end of the bandage 

is held between the index finger ami the thumli of 

the righl hand, close to the cylinder. With tins 
hand the bandage then i- revolved around the 
cylinder, which is held in the left hand, the free 
fingers of which aid in turning the cylindrical 
roll. The amount of ten-ion exerted upon the free 
end will determine the firmness of the completed 
roller. A toller bandage consists of the free end 
or initial extremity, the body, and the terminal 
extremity in the center of the cylinder. 

Triangular Bandage for the Head 

I ed to retain dressings on the forehead or 

scalp bold hack the base of the bandage about 

•2 inches, thus making a hem. Place the middle 

of the ha -e on the forehead ju-t abovethe eyebrows 
with the hem on the outside. Let the point fall 
over the head and down over the occiput (back 

of the head). Bring the ends of the triangle 

around the back of the head above t] 
them over the point and carry them around to the 
forehead and t ie in a square knot. Hold t he dress- 
ing linn with one hand and with the other, gently 
but firmly pull down on the point until the 



86 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 







Figure 83. — Triangular Bandage for Head. 

dressing is snug ; then bring the point up and tuck 
it over and in the bandage where it crosses the 
occiput. 

Triangular Bandage for Shoulder 

Used to hold dressing on the upper arm or 
shoulder, but two triangular bandages are neces- 
sary. Fold the first one into a narrow cravat. 
Place the base of the cravat on the top of the shoul- 
der on the injured side and bring the ends across 
the back and chest respectively ; continue under 
the opposite axilla and tie in front with a square 
knot. Before tying knot place a pad in the axilla 
on the uninjured side to prevent pressure by the 
narrow cravat. Turn up the base and make a hem 
of the second triangular bandage and apply it to 
the arm on the injured side. Carry the ends 
around behind the arm; cross and tie them in 
front. 

Support the dressings firmly with one hand 
and with the other, tuck the point of this triangle 
under and over the cravat on the shoulder until 
the dressings are held snugly in place. Pin the 
point to secure it. If no pin is available, the 
point of the triangular bandage can be folded 
under the cravat several times before the cravat 
bandage is applied. Remember, do not tie the 
ends around the arm too tightly. Check the distal 
circulation frequently. 







Figure 84. — Triangular Bandage for Shoulder. 

Triangular Bandage for Chest or Back 

Used to retain large dressings on the chest or 
back. For the chest drop the point of the triangle 
over the shoulder on the injured side, letting the 




Figure 85. — Triangular Bandage for Chest or Back. 



FIRST AID AND EMERGENCY PROCEDURES 



87 



base fall down over the injured area. The middle 
of the base should be direct 1\ beloM the Bhoulder. 
Bring the ends around the body to the back and 
tie them in a square knot directly below the 

shoulder. If the base bangs too low below the 
wound, it may be ahortened by folding it over 
several times before tying. This leave- one long 
end. Tie this long end to the point of the triangle 
lying over the shoulder, completing the procedure. 
Reverse the procedure for a back bandage, tying 
the end- over the, chest. 

Triangular Bandage for Hip 

Used to retain dressings on the buttock or hip. 
Make the first triangular bandage into a narrow 
cravat and tie it around the abdomen, with the 
knot on the uninjured side. Take the second 





Figure 66. — Triangular Bandage for Hip. 

triangular bandage and tuck its point up under 
the cravat, letting the base hang down over the 
thigh on the injured side. Make a hem along its 
base to the height desired and carry the ends 
around the thigh : cross in back and tie them on the 
outer side of the thigh. Hold the dressings in 
place and gently pull the point until they are 
well supported ; then secure the point with a sa fety 
pin or tuck under. 

Triangular Bandage for Foot 

Used to retain large dressings on the foot. 
After the dressings are applied, place the foot 
in the center of a triangular bandage and carry 
the point over the ends of the toes and over the 
upper side of the foot to the ankle. Fold in ex- 
ec-- bandage at the side of the foot, cross the 
end- and tie in a square knot in front. 



Triangular Bandage for Hand 

I • <! iu retain large dressings on the hand, 
titer the dressinge are applied place the ba 
the triangle well up on the palmar buH 

the wrist, ('any the point over I he end- of the 
fingers and buck of the hand well up on t he wrist. 





Figure 67. — Triangular Bandage for Foot or Hand. 

Fold the eZCeSS bandage at the ,-ide- of the hand 
in fold-, cross the end- around the wri-t. and tie 
in a square knot in front. (See tig S 

Cravat Bandage 

To make a cravat bandage, bring the point of 
triangular bandage to the middle of the base and 
continue to fold until the desired width i> obtained. 



88 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Cravat Bandage for the Head 

This bandage is very useful to control bleeding 
from wounds of the scalp or forehead. After plac- 
ing the dressing over the wound, place the center 
of the cravat over the dressing and carry the ends 
around to the opposite side; cross them and con- 
tinue to carry them around to the starting point 
and tie with a square knot. 





\L- 

Figure 88. — Cravat Bandage for the Head. 

Cravat Bandage for the Eye 

After applying a dressing to the affected eye, 
place the center of the cravat over the dressing 
and on a slant so that the lower end is inclined 
downward. Bring the lower end around under 
the ear of the injured side and the other end over 
the ear on the opposite side. Cross the end in 
back of the head; bring them forward and tie 
them over the dressing. 




Cravat Bandage for the Temple, Cheek, or Ear 

After the dressing is applied to the wound, 
place the center of the cravat over it and carry 
one end over the top of the head and the other 
under the jaw and up the opposite side, crossing 
them at right angles over the temple on the in- 
jured side. Continue one end around over the 
forehead and the other around the back of the 
head to meet over the temple on the uninjured side. 
Tie ends with a square knot. 






Figure 89. — Cravat Bandage for the Eye. 



Figure 90. — Cravat Bandage for the Temple, Cheek, or Ear. 

Cravat Bandage for the Elbow or Knee 

After applying the dressing to the elbow or knee, 
and if the injury or pain is not too severe, bend it 
to a right angle position before applying the band- 
age. Place the middle of a rather wide cravat 
over the point of the knee or elbow and carry the 
ends around the upper part of the elbow or knee, 
bringing it back to the hollow, and the lower end 
entirely around the lower part, bringing it back 
to the hollow. See that the bandage is smooth 
and fits snug, then tie with a knot outside of 
hollow. 



FIRST AID AND EMERGENCY PROCEDURES 



89 




Figure 91. — Cravat Bandage for the Knee. 




^P^ 



Figure 92. — Cravat Bandage for the Elbow. 

Cravat Bandage for the Arm, Forearm, Leg, 
or Thigh 

The width of the cravat t<> use will depend upon 
the extent and area <>f the injury. For a small 
area, place the dressing over the wound and center 
the cravat bandage over the dressing. Bring the 
ends around in hack, cross them, and tie over the 
dressing. For a small extremity it may he neces- 
sary to make several turns around in order to use 
all the bandage before tying, If the wound covers 
a larger area, hold one end of the bandage above 
the dressing and wind the other end spirally down- 
ward across the dressing until it is secure, then 
upward and around again and tie a knot where 
both ends meet. 

Cravat Bandage for the Axilla (Armpit) 

This cravat is to hold dressings in the axilla. 
It is similar to the bandage used to control bleed- 
ing from the axilla. Place the center of the band- 
age in the axilla over the dressing, and carry the 
ends up over the top of the -boulder and cross 
them. Continue across the back and the che-t. 
respectively, to the opposite axilla and tie them. 
Do not tie too tight or the axillary artery will lie 
compressed, adversely affecting the circulation of 
the arm. 




Figure 93. — Cravat Bandage for the Arm, Forearm, leg, or Thigh. 




Figure 94. — Cravat Bandage for the Axilla. 



90 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Cravat Bandage for a Sprained Ankle 

Do not remove the shoe. Leaving it on will af- 
ford partial support. If the top of the shoe is 
above the ankle, loosen the laces to allow for 
swelling. Use a narrow cravat and begin by 
placing the middle of the bandage under the heel ; 
carry the ends back and upward crossing above 
the heel and around forward, crossing over the 
instep. Now continue downward and backward 
again, this time close to the ankle and under the 




Figure 95. — Cravat Bandage for a Sprained Ankle. 

first turn, make a hitch and bring the ends for- 
ward, then around the ankle once more and tie over 
the instep. 

Roller Bandage 

In applying a roller bandage the roll should 
be held in the right hand so that the loose end is 
on the bottom ; the outside surface of the loose or 
initial end is next applied to and held on the part 
by the left hand, and the roll is then passed around 
the part by the right hand, which controls the 
tension and application of the bandage. Two or 
three of the initial turns of a roller bandage should 



overlie each other in order to secure the bandage 
and keep it in place. In applying the turns of 
the bandage it is often necessary to transfer the 
roll from one hand to the other. 

Bandages should be applied evenly, firmly, and 
not too tightly. Excessive pressure may cause 
interference with the circulation and may lead to 
disastrous consequences. In bandaging an ex- 
tremity it is therefore advisable to leave the 
fingers or toes exposed in order that the circula- 
tion of these parts may be readily observed. It 
is likewise safer to apply a large number of turns 
of a bandage rather than to depend upon a few 
too firmly applied turns to secure a splint or 
dressing. 

In applying a wet bandage, or one that may 
become wet in holding a wet dressing in place, 
it is necessary to allow for shrinkage. The turns 
of a bandage should completely cover the skin, as 
any uncovered areas of skin may become pinched 
between the turns, with resulting discomfort. 

In bandaging an extremity it is advisable to 
include the whole member (arm and hand, leg and 
foot), excepting the fingers and toes, in order that 
uniform pressure may be maintained throughout. 
It is also desirable in bandaging a limb that the 
part be placed in a position it will occupy when 
the dressing is finally completed, as variations in 
flexion and extension of the part will cause 
changes in the pressure of certain parts of the 
bandage. 

The initial turns of a bandage of an extremity 
( including spica bandages of the hip and shoulder) 
always should be applied securely and, when pos- 
sible, around the part of the limb that has the 
smallest circumference. Thus in bandaging the 
arm or hand the initial turns usually are applied 
around the wrist, and in bandaging the leg or foot 
the initial turns are applied immediately above 
the ankle. 

The final turns of a completed bandage usually 
are secured in the same manner as are the initial 
turns, by the employment of two or more over- 
lying circular turns. As both edges of the final 
circular turn are necessarily exposed, they should 
be folded under to present a neat, cufflike appear- 
ance. The terminal end of the completed bandage 



FIRST AID AND EMERGENCY PROCEDURES 



91 



is turned under and secured to the final turns bj 
either a safety pin or adhesive tape. When these 
are not available, the end of the bandage maj be 
split lengthwise for several inches, and the two 
resulting tails secured around the part by tying. 

Roller Bandage for the Hand and Wrist 

For the hand and wrist a figure of-eighl band- 
age is ideal. Anchor the dressing, whether it be 
on the hand or wrist, with several turns of m 2 or 
3-inch bandage. If on the hand, anchor the 
dressing with several turns and continue the band- 
age diagonally upward and around the wrisl and 
back over t lu- palm. Make a> many t urns as neces- 
sary to properly secure the dressing. 




Figure 96. — Roller Bandage for the Hand and Wrist. 

Roller Bandage for the Ankle and Foot 

The figure-of-eight bandage is also used for 
dressings of the ankle a> well as for supporting 
a sprain. While keeping the fool at a right angle, 
start a 3-inch bandage around the instep for sev- 
eral turns to anchor it. Carry the bandage up- 




ward over the instep and around behind the ankle, 
forward and again across the instep and down 
under the arch, thus completing one fig 
eight. Continue the figure-of-eight nun- ovi 

lapping one third to one half it.- width, with an 

isional turn around the ankle, until the dre 
ing is Becure or until adequate support is obtained. 

Roller Bandage for the Knee 
The -pica or figure-of eight bandage of the knee 

is -i m ilar to I hat of I he el how anil i> used to retain 
dressings in the region of the knee joint. Make 
two circular turn- around the thijzh just above 
the knee and carry the bandage diagonally down- 
ward across the kneecap and encircle the leg below 
the knee with another circular turn. Carry the 

bandage diagonally upward, again crossing the 

kneecap to the basic anchor turn. Make another 

circular turn, repeat the figure of-eight procedure, 
overlapping each previous turn about two-thirds 
the width of the bandage, and gradually ascend 

the knee. Secure the bandage with several circu- 
lar turns above the knee and tie. To -.cure the 

dressings in the hollow of the knee, reverse the 
procedure and cross the bandage in the hack. 




Figure 97. — Roller Bandage for 'he Ankle and Foot. 



Figure 98. — Roller Bandage for the Knee. 

Roller Bandage for the Heel 

The heel is one of the mo-t difficult part- of the 
hody to bandage. Place the fret* end of the band- 
age on the outer part of the ankle ami bring the 
bandage under the foot and up. Then carry the 

bandage over the instep, around the heel ami hack 
o\er the instep to the starting point. Overlap 
the lower border of the first loop round the heel 
and then repeat, the turn overlapping the upper 

border of the loop around the heel. Continue 
these tutu- until the desired number <>f turn- i- 
obtained ami -ecu re w lth several turn- around the 
lower leg. 



92 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 99. — Roller Bandage for the Heel. 

Roller Bandage for the Elbow 

A spica or figure-of-eight type of bandage is 
used around the elbow joint to retain dressings 
over wounds in the region of the elbow and to 
allow a certain amount of movement. Flex the 
patient's forearm slightly, if you can do so with- 
out causing him too much pain, and anchor a 2- 
or 3-inch bandage above the elbow with two cir- 




cular turns. Carry it diagonally downward across 
the hollow of the elbow and encircle the forearm 
below the elbow with a circular turn. Continue 
the bandage diagonally upward across the hol- 
low of the elbow to where you started ; make an- 
other circular turn around the upper arm, carry 
it downward, repeating the figure-of-eight pro- 
cedure, and gradually ascend the arm. Overlap 
each previous turn about two-thirds of the width 
of the bandage. Secure the bandage with two 
circular turns above the elbow and tie. To secure 
dressings on the tip of the elbow, reverse the 
procedure and cross the bandage in the back. 

Roller Bandage for the Forearm, Leg, and 
Thigh 

The spiral reverse bandage must be used to 
cover wounds on these parts ; only such a bandage 
can keep the dressing flat and even. Make two 
or three circular turns around the lower or smaller 
part of the limb to anchor the bandage and start 
upward, going around and around, overlapping 
about one-third to one-half the width of the 




s. 



A 



Figure 100. — Roller Bandage for the Elbow. 



Figure 101. — Roller Bandage for the Forearm, Leg, and Thigh. 



FIRST AID AND EMERGENCY PROCEDURES 



93 



previous turn, and continue B£ long a> Bach turn 

lies flat. When the edge of a turn is loose it is 
then necessary to use the reverse lap. Continue 
the spiral, making the re\ erse laps when necessary . 
and secure tlic end when completed. Note thai 
it is not necessary to reverse each turn as is 
described in most text hooks. 

Velpeau Bandage 

The Angers of the affected side are placed upon 
the opposite shoulder, a pud placed in the axilla, 
and the skin surfaces separated by sheet wadding. 



Place the initial end of the bandage across the 
outer portion of the affected Bhoulder, dowi d 
ovei the outer and posterior Burface of the flexed 
arm, behind the point of the elbow, obliquely 
across the hack of the forearm and chest to the 
opposite axilla, and around to the point of origin. 
A iter repeat i 1 1 «_r i lii- turn once, t he bandage is car 
ried from the point of origin across the back and 

Bide of chest, in front of the Hexed elbow and 

transversely across the front of the chest Then 

it is carried around the other side of the chest, 

diagonal!) across the hack to the affected Bhoulder. 









Figure 102. — The Velpeau Bandage. 



94 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



The first turn then is repeated, followed by a 
second circular turn around the chest and flexed 
arm. 

Each vertical turn over the shoulder overlaps 
two-thirds of the preceding turn, ascending from 
the outer part of the shoulder to the neck and 
from the upper posterior surface of the arm in- 
ward toward the point of the elbow. 

Each transverse turn also overlies one-third of 
the preceding turn. These transverse turns are 
continued until the last turn covers the wrist. 
The bandage is finally secured with pins, both 
where it ends and at various points where the 
turns of the bandage cross each other. (The ini- 
tial turns of this bandage may be secured by circu- 
lar turns around the chest under the arm of the 
affected side.) 

Uses. — Fixation of arm in treatment of frac- 
tured clavicle and fixation of humerus after re- 
duction of dislocated shoulder joint. 

Barton Bandage 

With the initial end of the bandage applied to 
the head just behind the right mastoid process, the 
bandage is carried under the bony prominence at 




Figure 103. — The Barton Bandage. 

the back of the head, upward and forward back 
of the left ear, obliquely across the top of the head, 
downward in front of the right ear, under the 



chin, upward in front of the left ear, obliquely 
across the top of the head, crossing the first turn in 
the midline of the head, thence backward and 
downward to the point of origin behind the right 
mastoid, then it is carried around the back of the 
head under the left ear, around the front of the 
chin, under the right ear to the point of origin. 
This procedure is repeated several times, each turn 
exactly overlying the preceding turn. The band- 
age is secured with a pin or strip of adhesive tape, 
and either a pin or adhesive may be applied at 
the crossing on top of the head. 

Uses. — Fracture of low T er jaw and retention of 
dressings of chin. 

TRANSPORTATION OF THE INJURED 

The method of transporting a seriously injured 
person cannot be overemphasized. It is just as 
important as any other first-aid procedure. The 
patient's life as well as much of the further treat- 
ment may depend upon the manner in which you 
move and transport him after the accident. 

General Procedures 

1. The various methods of carrying should only 
be used to remove a patient from a dangerous area, 
such as a fire, or when it is the only means of 
transportation available. They should not be 
used unless the victim is only in need of slight 
support or when he is to be moved for only a short 
distance. 

2. First, see that all hemorrhage has been ar- 
rested, fractures and dislocations immobilized, 
wounds dressed, pain controlled, and the treat- 
ment for shock instituted, if necessary, before 
moving the patient. 

3. Protect the patient against exposure by 
covering him with a sufficient number of blankets, 
garments, or with whatever material is available. 

4. Be gentle in moving him so you do not ag- 
gravate the patient's condition by rough handling. 

5. Certain injuries require special handling in 
order that further injury is not produced and 
that splints and dressings do not come loose. See 
that the patient is transported or carried in such 
a way as to protect his injuries and that harmful 
pressure is not applied t<5 the injured area. 



FIRST AID AND EMERGENCY PROCEDURES 



95 



6. A patient suspected of having a fractured 
spine should be transported in such a way thai 
the spine is in a position of extension. This can 
be accomplished by placing a folded blanket or 
pillow under the small of the back, 

7. Whenever possible, carrj the stretcher to the 

patient and not the patient to the stretcher. 

8. Secure the patient to the litter .so that there 

is no danger of hia falling out. and in case of a 
fracture of the neck or spine see that there is ad- 
equate immobilization. 

9. Four men are necessary to carry the litter 
and an additional one. if available, can help to 

attend to the Deeds of the injured as he i> being 

transported. See that you have an adequate Dum- 
ber of hearers. 

Tie Hands — Drag Carry 

The "Drag" is used to drag or haul an uncon- 
scious patient from beneath a low structure and for 
a short distance. Tie the patient's wrists around 
your neck. By raising your shoulder, you will 
be able to lift bis bead and shoulders above the 
ground and drag him. 




Figure 104. — The Drag Carry. 

Chair Used as a Litter 

A convenient method of carrying a person, par- 
ticularly an ill person, without a stretcher is to 
seat the patient on a strong chair and have two 
bearers lift the chair. The chair must always be 
carefully tested for strength. 



Tin- method U valuable for carrying a pat 

up or down a [adder, particularly in placet u here 

a -tiei, her cannot be used because of narrow wind- 
ing ladders or small doorways. 




Figure 105. — Chair Used at a Litter. 

Blanket Drag 

Patient is placed on blanket and moved by pull- 
ing end of blanket. This type of transportation is 
excellent when patient is Unconscious, with injuries 
which forbid handling or Lifting by a single bearer. 



&E^r^ 




Figure 106. Blanket Drag. 

Arm Carry 

For patient- not seriously injured, but who mu-t 
be carried because they are unconscious or because 

walking would make their condition \\. 



96 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 107. — Arm Carry. 

Fireman's Carry 

This is one of the easiest methods to carry an 
unconscious patient and one which has proven to 
be the most practical. Turn the patient on his face 
and kneel on one knee at the head of the patient, 
facing him. Place both hands under the armpits 
and gradually work them down the patient's side 
and across his back. Raise the victim to his knees ; 
then take a firmer hold across the back and raise 
him to his feet. Next seize the right wrist of the 
patient with your left hand and draw his arm 
over your head and down your left shoulder. 

At the same time reach down with your right 
arm and pass it around the victim's right thigh 
and grasp his right wrist. This leaves your left 
hand free. In lowering the patient the procedures 
are reversed. Should the patient be wounded in 
such manner as to require the procedure to be 



conducted from the right side instead of the left, 
simply change the hand and proceed in the same 
manner, substituting the right for left and vice- 
versa. (Fig. 108.) 

One Man Supporting Carry 

A patient who is only slightly injured may be 
assisted in walking by one bearer. The patient 
walks, leaning against the bearer's right side. 




Figure 109. — One Man Supporting Carry. 



FIRST AID AND EMERGENCY PROCEDURES 



97 










Figure 108. Firemon's Carry. 



98 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Pack Strap Carry 

This is a valuable carry when the patient's 
injuries do not prohibit its use. A bearer can 
carry a greater weight with safety this way than 
in any other carry. 

Bring the patient's arms across the bearer's 
shoulders, taking great care that the patient's arm- 
pits are well up on the shoulders. The arms are 
crossed in front where they may be held in place 
by one of the bearer's hands, thus leaving the 
other hand free. This is very useful in lifting a 
patient from a bed or chair. 




Figure 110. — Pack Strap Carry. 

Army Litter 

The army litter is made essentially of canvas 
and is supported by wooden or aluminum poles. 
It is collapsible and is the most practicable for 
use in the field. 




Figure 111 . — The Army Litter. 

Stokes' Stretcher 

In most instances when the hospital corpsman is 
faced with the problem of transporting a severly 
injured person, the Navy's service litter called the 
Stokes' stretcher will be available. It is a wire 
basket supported by iron or aluminum rods. It 
is used aboard ship especially for loading patients 
to and from the boats. 

Before placing the patient in a Stokes' stretcher, 
cover the stretcher with two blankets placed 
lengthwise, so that one blanket extends down each 
leg, and use a third blanket folded in half in the 
upper part of the stretcher to protect the head and 
shoulders. Lower the patient gently onto the 
stretcher and make him comfortable. Secure the 
patient's feet to the foot of the stretcher to prevent 
him from sliding up and down. Cover him with 
blankets and secure him in place by using the three 
straps and fastening them over his chest, hips, and 
knees. 




Figure 112. — The Stokes' Stretcher. 

Neil Robertson Stretcher 

The Neil Robertson stretcher officially adopted 
by the British Navy is especially adapted to trans- 
port casualties from engine rooms, holds and 
other compartments where access hatches are too 
small to permit the use of the Stokes' or Army 
litter. The stretcher is made of semirigid canvas 
and is wrapped around the patient like a mummy 
wrapping. This permits him to be hoisted out of 
these difficult places. 



FIRST AID AND EMERGENCY PROCEDURES 



99 



^^v 



TTT 



i i 
! I 



! I 



Figure 113. — The Neil Robertson Stretcher. 

MISCELLANEOUS EMERGENCIES 

Foreign Bodies in the Eye 

Cinders, steel fragments, portions of emery 
wheels, particles of dirt, and eyelashes are the most 
common foreign bodies found in the eye. They 




Figure 114. — Removing a Foreign Body from the Eye. 

may be under the upper or lower eyelid <>r on the 
coi uea. 

Removal 

1. The lower eyelid should be pulled down first, 
if the foreign body is seen, it may be removed 

on the tip of a small cotton -wah which ha- been 
moistened with boric acid solution. 

2. The upper lid may be examined by standing 
back of the seated patient whose hcid is inclined 

backward. Have the patient look down, grasp 
the eyelashes and turn back the upper lid over 
a smooth applicator or probe, If the foreign 
body i- seen, remove with -mall cotton applicator 
moistened with boric acid Bolution. 

3. If the foreign body cannot be seen on the 
upper lid. examine the eyeball If seen, try re- 
moving it with a line wire loop curette. Use a 
quick flicking motion. Do not drag wire loop 
aero— the cornea. To aid the patient it ma\ be 
necessary to instill one or two drop- of pontocaine 
solution in the eye. I f there i- no wire loop avail- 
able, use a small cotton swab moistened with boric 

acid solution. l*-e a quick flicking motion. Do 
not drag aero-- the cornea. If these method- fail, 
do not try anything else. In-tdl a small amount 
of pontocaine ophthalmic ointment. • ..\ . i the eye 
with an eye patch or dressing, and gel patient to 
a medical officer a- -oon a- possible. 

L After the object i> removed, irritation may 
cause the patient to complain that the ofa 
>till in the eye. Apply a -mall amount of boric 
acid ophthalmic ointment to relieve the irritation. 

5. If no foreign object can be found on exam- 
ination, have the patient wadi the eye with an 
eyecup, using boric acid solution. This may aid 



100 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



in either removing the object, or bringing it into 
view where it can be seen and removed. 

Caution: Never use a metal probe or eye in- 
strument about the eye, other than a fine wire 
loop curette as described above, and as an aid in 
everting the upper lid. Any object which can- 
not be removed easily with the wire loop curette 
or cotton swab should be touched only by a med- 
ical officer. 

Foreign Bodies in the Ears 

Small objects may be introduced into the ear 
by children or insane patients; insects may enter 
at times when the individual is asleep; the usual 
foreign body is earwax which, in some individuals, 
forms and hardens rapidly. 

1. An object may be removed by using a fine- 
wire curette if it can be seen. 

2. Insects can be very annoying. Use two or 
three drops of a light oil, kerosene, or ether. 
Syringe with warm boric acid solution. 

3. Do not syringe with water or boric acid solu- 
tion if the object is of vegetable origin such as a 
pea, bean, or seed. This may cause them to swell 
and be difficult to remove. If they cannot be seen 
and easily removed, leave them alone until they 
can be removed by a medical officer. 

4. Wax may be removed by irrigation with 
warm boric acid solution. If the wax is not re- 
moved, try placing a few drops of hydrogen 
peroxide or glycerin in the ear, then syringing 
after a few hours. This procedure may have to 
be repeated daily for several days before all of 
the hardened wax is removed. Let the peroxide 
or glycerin remain overnight each time, in dif- 
ficult cases. 

Foreign Bodies in the Throat 

These may be fish bones, masses of food, or 
other objects which have been placed in the 
mouth. 

1. If a fish bone, and it can be seen, it may be 
removed with forceps or fingers. If the bone can- 
not be seen, get the patient to a medical officer as 
soon as possible. 

2. If a mass of food, try removing it by thrust- 
ing the fingers into the throat. If it cannot be 
removed, this may cause vomiting which may eject 
it. 



3. If the object is causing difficulty in breath- 
ing, try placing the patient over a chair or bench 
with the head low and striking a sharp blow be- 
tween the shoulders. 

4. If the object cannot be removed easily, get 
the patient to a medical officer as soon as possible. 

Foreign Bodies in the Stomach 

Usually, these are not serious. If sharp pointed 
objects such as pins, tacks, brads or other sharp- 
edge objects are swallowed : 

1. Do not give laxatives of any nature. 

2. Feed patient foods with considerable bulk, 
such as bread, potatoes, and bananas. 

3. Get the patient under the care of a surgeon 
as soon as possible. 

Foreign Bodies in the Skin 

These may be splinters, thorns, needles, pins, 
fishhooks, glass, nails, and similar objects. Many 
foreign bodies cause absolutely no symptoms and 
it is better to leave them alone. Many persons 
carry bullets or small pieces of shrapnel in their 
bodies with no symptoms or inconvenience. 

1. Splinters and thorns may be removed by 
passing the point of a knife or forceps under the 





1. Showing hook buried in 
finger. Barb prevents 
removal. 



2. Barb pushed through skin. 





3. Barb clipped off. 4. Barbless fishhook withdrawn. 

Figure 115. — Removing a Fishhook from the Finger. 



FIRST AID AND EMERGENCY PROCEDURES 



101 



objects Mini with the thumbnail press the Bplinter 
against i he blade. 
•1. To remove objects From under :i nail, cut a 

notch in tlic nail to expose the end of the object, 
then it may be removed. 

:;. Sonic objects such as a needle or fishhook may 
be pushed through the part and removed. It is 
best to cut oil' the end of a fishhook hefore 
removing. (Fig. 115.) 

Alter objects arc removed, treat as any wound. 
Cleanse, apply disinfectant such as tincture of 
merthiolate and apply sterile dressing. 

Rings on swollen fingers can usually be removed 
using soap or petrolatum. It may be necessary 
to cut it with a wire cutter or tile, being careful 
to protect the turner. 

Heat Stroke — (Sun Stroke) 
Cause. — Exposure to excessive heat. Usually 

the direct ray- of the sun. 

Symptoms. — Headache, dizziness, frequent de- 
sire to urinate, irritability, disturbed vision, 
usually objects have a red or purplish tint. Pa- 
tient suddenly falls unconscious; skin dry and 
hot: pupils contracted: pulse full, strong, and 
bounding; may he convulsions; temperature of 
body from 105° to 10!)° F. 

Treatment. — This condition is serious. Re- 
duce the temperature rapidly. 

1. Remove the patient to shade or coolest place 
available. 

2. Kemove clothing. Lay patient on hack witli 
head and shoulders slightly elevated. 

3. Pour cold water over body, or if available, 
place in tub of cold water. 

4. Rub body with ice. Place piece of ice in 
armpits. Ice cap on head. 

:<. ( 'over with sheets soaked in ice water. 

6. If temperature does not readily reduce, use 
cold salt water enemas. 1,500 to 3,000 cc, fre- 
quently. 

7. (iive cool (not iced) drinks after conscious 
iir-- returns. 

8. Do not give stimulants. 

Heat Exhaustion (Heat Cramps) 

Caused usually by loss of salt and water from 
the body by perspiration. Excessive heat. 
Under the same conditions one person may de 
velop heat exhaustion, another heat stroke. Heat 
311888*— 53 8 



exhaustion is more frequently found in hot. humid 
places, a- the room- aboard -hip. 

Symptoms. — Dizziness; profuse perspiration; 
nausea and vomiting; fainting; muscle cramps; 
skin. pale, moist, cool: temperature subnormal : 
pulse, weak, rapid ; pupil- u-ually dilated ; shallow 

respirations; usually aroused easily. 
Treatment. 1. Remove to cool area. 
2 Keep lying down: treat for -hock. 

8 Keep warm. ( Jive -I imiilanl-. 

4. Give freely hot water or roller to which ha- 

been added one half tablespoon -ah to each glass 
or cup. 

.">. Muscle cramps may be relieved by hot appli- 
cations or immersion of part in hot water. Hot 

water bottles may help give relief. 

6. .Morphine. ' , grain, nia\ be given to relieve 
muscular cramp- if necessary. 

Notk — it lias been Bhown that II i- desirable for men 
working 1 in high temperatures t.> drink water containing 
0.1 to 0.3 percent salt. Salt tablets are available tot 
and should i>e placed where readlrj accessible to all \—r- 
sonnel. Excessive amounts of salt should be avoided as 
it will lead m thirst, gastrointestinal irritation-. mnsos. 
diarrhea, and a decrease in the effldencv of personnel. 
Men should be encouraged to drink water in excess of the 
amount required to quench thirst, ;i- It la more benefldal 
under these conditions, 

Frostbite 

Frostbite is the term usually applied to injuries 
resulting from exposure to dry cold. 

Immersion or immersion foot is the term usually 
applied to injuries resulting from prolonged im- 

nier.-ion of the part in cold water. This condition 

is found frequently among Burvivora of ship- 
wreck-, especially the feet, due to Bitting on life 

rafts with feet in the water. 

Treatment for both conditions is for all prac- 
tical purposes the -ame. 

1 If conscious, and feet are affected, do not 
permit patient to walk. 

2. (Jet patient into a moderately warm room, 

undressed as quickly as possible. 

:;. immerse in bath at L06 to 110° F. for 10 
minutes. 

4. Dry carefully and place in bed. keep covered, 
hut do not permit cover to come in contact with 
affected part-. 

5. Do not rub or massage part-. If hands or 
feet arc affected keep slightly elevated, move 



!.02 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



frequently, support the part well, and protect pres- 
sure points with use of doughnut dressings. 

6. Keep parts dry ; dry, clean, sterile cotton be- 
tween the toes and ringers. 

7. Inject 300,000 units penicillin to help combat 
infection. 

8. Get the patient to a hospital or under the 
care of a medical officer as soon as possible. 

Note — When handling cases of frostbite, do not touch 
the skin any more than necessary. Massaging or rubbing 
the part will break the skin permitting infection to start 
more rapidly. 

Do Not Rub the Parts With Ice or Snow! 



EMERGENCY MEDICAL TREATMENT 

The main objective of this section of the hand- 
book is to present material that will aid the corps- 
man in the recognition of disease and will intro- 
duce a plan of conservative treatment that may be 
instituted for each disease and condition discussed. 
It is to be remembered that disease is very often 
not sharply demonstrated in the human body and 
therefore can present an extremely baffling pic- 
ture. To be able to make a fine, differential 
diagnosis is not the problem of the hospital 
corpsman. 

But while on independent duty, it becomes nec- 
essary for the corpsman to have a general knowl- 
edge of disease, a good understanding of the 
methods of recognizing disease, and the common 
sense ability to decide what the course of action 
shall be. Modern communication systems make 
contact with medical help possible in most situa- 
tions. The corpsman should never hesitate to ask 
for help. 

The corpsman should record accurately all ob- 
servations made by him and all complaints given 
by the patient. He should not allow the facts to 
become "cool," but should write them down as 
soon as possible. He should record all treatments 
promptly. The more information the medical of- 
ficer receives, the more quickly he will be able to 
diagnose the condition being considered. 

Suggestions set forth here are limited in con- 
tent. The hospital corpsman should have reliable 
and up to date reference books and current mate- 
rial at hand at all times so that he can keep abreast 



in the field of medical science and thus be able to 
meet situations promptly and with a greater de- 
gree of assurance. 

Diagnosing, Clinical Observation, Sample 

Radio Dispatch 

Points to be remembered in diagnosing: 

History of illness. — Consider a patient who 
comes to you as an individual, not as an illness or 
condition. Try to consider how the ailment affects 
the individual as a whole. 

Size up the patient. Let him teiryou his story. 
Make all your questions direct and simple. 

Try to determine the severity of his condition. 
Is it progressing rapidly or slowly ? 

When was the onset ? Remember, a condition 
that has been going on for a long time without 
change usually is not something about which one 
needs to become alarmed. If the onset has been a 
matter of hours or even a day or two with pro- 
gressive change for the worse, an attempt should 
be made immediately to determine the nature of 
the illness. 

If the patient's statements give you no clue, 
attempt to localize the condition to one of the sys- 
tems of the body through questioning. Begin with 
the head and go down the body, asking questions 
related to the various systems. 

The head 

Discharge from ears. 
Ringing in the ears. 
Loss of hearing. 
Discharge from nose. 
Nose bleed. 
Frequent head colds. 
Tooth trouble. 
Headache. 
Cardio-respiratory system 
Pain in chest. 
Palpitation. 
Dyspnea. 
Night sweats. 
Spitting up blood. 
Cough — type of cough. 

Gastrointestinal system 

Eating habits — Is appetite good? Can he eat 
all foods? Or must he watch his diet? 
Gas or heartburn after meals. 
Vomiting blood (coffee grounds). 



FIRST AID AND EMERGENCY PROCEDURES 



103 



Bowel habits diarrhea, constipation, pain (if 
so, where is pain), are cathartics necessary, bright 
blood or tarry stools, hemorrhoids. 

Abdominal pain where, type, relation of pain 
to meals. Docs it occur afterward or between 
meals '. 

Urinary system 

Frequency of urination. 

Pain or burning sensat ion. 

Amount of urine — appearance of (smoky, 

cloudy, puslike, bloody, dark amber color). 

Genital system 

Presence of VI) lesion at any time. 
Inflammation. 
Pain — type. 
Enlargement of glands. 

Neuromuscular system 

LOSS of memory. 

Moods, disposition. 
Nervousness, 

State of mind. 

Ask about pain and motility of joints; cramps 
in muscles. 

Habits 

Coffee, smoking, drinking, drugs. 

Sleep, personal hygiene. 

Possibility of working habits affecting person; 
e.g., a man with headache, vertigo, muscular 
weakness, vomiting, stupor, who comes in contact 
with fumes from furnaces or engines, might be 
suspected of carbon monoxide poisoning. 

Physical examination (after eliciting as much 
information from the patient as possible, a phys- 
ical examination may be necessary). 

Vital signs 

Take TPK and blood pressure. 
Head 

1. Note any swelling or growths. 

•1. Tenderness — over sinuses or mastoids. 

.">. Look at eyes for unequal pupils, unu.-ual 
movement of eyeballs; check eye- for accommo- 
dation to light. 

I. Nih' — -welling; does it appear to be 
broken; note discharge, obstruction. 

5. .Mouth — tongue coated, very red. very dry. 
Anv decayed teeth, bums bleeding or inflamed. 



Any eruptions or discolorations in mucous mem 
branes. Throat condition red: membranes or pus 
present Condition of tonsils if present. 

Neck 

('heck lymph node- behind car-, down side of 

neck, and over collar hone. Any enlargement in 

area of thyroid or other part- of neck. 
Chest 

1. Is a cough present i U r M development of 
COUgh rapid or -low? Could il be due to post 

nasal drip of Binusitis I 
\>. Listen for rale- (moist, crackling Bounds) 

with Stethoscope if one i- available. 

."». Check sputum — i- it clear, mucoid, g 
or yellow pus, or bloody I 

1. Heart — pain- in the heart that are of stick- 
ing nature, occurring intermittently, are usually 
due to excitement or ten-ion. Crushing pain in 
chest with radiation to the sternum and down 
the left arm is of serious nature. Blood pressure 
and pulse readings are of consequence in con- 
nect ion with the latter. 
Gastrointestinal tract (palpate the abdomen). 

Have patient lying on back, undressed, Make 

certain your hands are warm. Gain patient's 
confidence and relax him b\ pressing abdomen 
gently in area where there i- no pain. Gradually 
move your hand toward any tender -pot-. 

1. In appendicitis, there usually is rebound 
tenderness; i. <■., when suddenly releasing the left 

side of the abdomen, pain will occur in the right 
side. 

•_'. Perforated peptic ulcer — sudden excruciat- 
ing pain in abdomen with boardlike rigidity. 

.".. Distent ion Bhould l*- noted. 

4. Pain of any type: colicky, generalized, lo- 
calize! 1. etc. 

\otc movement <>f abdomen during respira 

tions; e. i_ r .. in abdominal injuries oftentimes the 
pat tent breathes only with the thoracic mu-ch-. 

Genitourinary system 

l. If pain i- present in kidney area, it may 
radiate down into the groin and genitalia. I 
examine, place one hand on the abdomen, one 
under the back of loin. Upon gentle palpation one 

feel- the muscle- ale rigid in the loin. Tender- 
u the region may also Ix> present. The other 

side Bhould also be palpated for comparison. 



104 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



2. Check urine carefully for albumin, pus, 
blood. Microscopic examination should be done 
if possible. Remember any time disturbances oc- 
cur in the kidneys, bladder, or ureters, evidence of 
this can be found in the urine. 

3. Examine genitalia for enlargement, lesions, 
redness. 

Extremities 

1. Check for injuries — type. 

2. Is pain present ; if so, where ? 

3. Note swelling. 

4. Is entire limb involved, or is the condition 
localized. 

5. Upon moving joints, note if movement is 
smooth or crackling. 

After the history and physical examination are 
completed, positive findings should be noted and 
a tentative diagnosis made. 

Radio dispatch at sea for advice in care of sick 
or injured 

General points to be remembered : 
Ship information, such as latitude, longitude, 
destination, etc., is an administrative problem and 
will be supplied by the officer responsible for the 
same. 

The place to radio will depend upon circum- 
stances and ship's location. 

Write the message in your own words, being 
sure to leave out any unnecessary words, and then 
submit it to the executive officer. 

Accuracy and completeness of information can- 
not be overemphasized. The listing below in- 
cludes the points concerning the patient that 
should be considered when composing a radio 
dispatch : 

Patient's age. 

Description of type of pulse and respiration, 
especially if the patient is acutely ill. 

Patient's mental state — conscious, stuporous, 
delirious, etc. 

If the temperature was taken rectally or by 
axilla — this must be mentioned. 

Onset and duration of illness. Is there a 
progressive change for the worse. 
Brief history. 

Habits of individual that may have bearing 
on his condition. 

Principal complaints. 



Associated symptoms of note, including uri- 
nalysis if possible. 

In the case of injuries, cause, location, amount 
of bleeding, deformity caused by the injury, 
and other significant signs should be included. 

Treatment you have instituted. 
Make sure you confine all statements to facts as 
found by you when you examined the patient and 
as related to you by the patient. 
Sample message (as you might prepare it) : 

Request advice and treatment concerning 
Brown. Hugh T., SN, age 20; conscious; speech — 
clear, coherent. 

History, symptoms. — Onset sudden — 2 hours 
ago, hard chill, immediate rise in temperature. 
No previous attack. Past history negative ex- 
cept for cold last week. 

Temperature 104. Pulse 136, regular, strong. 
Respirations 38, quiet, labored, cause pain right 
side chest. B. P. 124/82. Chest pain aggravated 
by breathing, coughing. Expectorating small 
amount thick blood, streaked sputum. Patient 
looks toxic. No other cases on board. 

Treatment.^To bed. Aspirin, 10 grains, pro- 
caine penicillin 300,000 units 1045. Forcing 
fluids. Light foods. 

MEDICAL CONDITIONS 

Angina Pectoris 

Cause. — Occurs due to a slackened supply of 
fresh oxygenated blood to the heart muscle and 
oftentimes accompanies hardening of the arteries. 

Symptoms. — Occur when the individual has 
exerted himself, either through exercise or some 
emotional strain. Pain — sudden pain that radi- 
ates over chest and sometimes down the left arm, 
also to the back. Is of a crushing nature, often 
described by the patient as feeling that his chest 
is in a vise. With rest the pain will generally sub- 
side. Dyspnea and tachycardia are usually pres- 
ent. Occasionally there may be digestive disturb- 
ances. 

Treatment. — 1. Rest, both physical and mental. 

2. Nitroglycerin, 1/150 grain, under the tongue 
or inhalation of vapors from an amyl nitrite perle 
should bring relief from pain. Nitroglycerin may 
be repeated every 5 to 10 minutes for three or 
four doses. If pain has not been relieved in y 2 



FIRST AID AND EMERGENCY PROCEDURES 



105 



hour, give ' i grain morphine sulfate or LOO mg. 
of demerol subcutaneously rather than continue 
with the nitroglycerin. If nitroglycerin brings 
relief after one or more tablets, it may be repeated 
several times :i day it' necessary. 

.">. Discourage overeating, smoking. 

4. Hospitalize for check-up ;i> quickly as pos- 
sible. 

Coronary Thrombosis and Occlusion 

Cause. — Unknown except that arteriosclerosis 
usually plays a part in bringing about total ob- 
struction of one of the coronary vessels, either be- 
cause of a clot or because of thickening of the 

arterial wall. Most prevalent in persons over in. 
Symptoms. — Pain — agonizing, compressing, 
crushing pain in chest that radiates down he- 
low the sternum, often down the left arm. up into 
the neck, and sometimes over the gastric region. 
If this pain Lasts 30 minutes or longer, damage to 

the heart muscle can be considered serious. Color 
ashen. Symptoms of shock, such as a precipitate 
drop in blood pressure, a weak, rapid pulse, and 
cold, clammy skin. Increased respirations. After 
12 to 24 hours, a moderate fever develops. Sedi- 
mentation rate and WBC later become elevated. 
Treatment. — 1. Make the patient as comfort- 
able as possible where he is, and give morphine 
sulfate, 'i grain, or demerol. .~>0 to 1(10 mrr. sub- 
cutaneously without delay: repeat in .'50 minutes 
if the pain has not been relieved. 

2. When the pain subsides, move the patient to 
bed or bunk. Absolutely avoid all physical and 
mental Strain on the part of the patient. 

3. For cyanosis and anoxia, give oxygen. 

4. Diet i -.r "< 'ardiac diet"), avoid iced or stim- 
ulating drinks. 

5. This i- a grave medical emergency and re- 
quires expert nursing care. Transfer by stretcher 
to a hospital as quickly as possible i> Imperative. 

Diabetes Mellitus 
See Nursing and Nursing Procedun 

Gastroenteritis 
Cause. — Caused by any food. Liquid, or drug 

that irritates the lining of the Stomach and i n t • 
tines. Preformed toxins or organisms which cause 
an Infection of the gastrointestinal tract will pro- 
duce symptoms of gastroenteritis. 



Symptoms. — Will vary according t" the sever- 
ity of the irritation. Loss of appetite, fol 
by nausea an. I vomiting. Abdominal pain and 
diarrhea. Fever. Tenesmus. Sometimes bloody 
Btools. Dehydration x-v ill follow quickly in Bevere 
cast 

Treatment.— 1. Bedrest with bathroom privi- 
leges UnleBS I he pal ient IS too ill. 

•_'. Nothing by mouth during period of nausea 

ami \ oniii in^r. 

:;. Tr. Belladonna gtt. XII to X\'. a- tolerated 

by the patient four I inn- a day: paregoric I 0C 
every t hour- for diarrhea. 

1. For dehydration, 5-percent dextrose in iso- 
tonic Saline 1. I CC. 1. V. daily: any additional 

I. V. fluids given should !»■ 5-percen( glucose in 

water. 

After nausea subsides, clear liquid-, such as 

bouillon, tea. and thin, cooked cereal- may In- 

given. Soft cooked fond- (see chapter on diet-) 

may he added a- tolerated. 

6. If the symptoms do not subside in a mat- 
ter of Is to ■_'( hour- with the ahove treatment, if 

the patient is not vomiting frequently, and if fever 

is Mill present, aiireoinvcin in the dosage of 260 

mgs. every 6 hours by mouth may he helpful. 
If aureomycin is not available, Chloromycetin or 
terramycin may he given, using the Bame dosage. 

Any one of these drugs may he L rivcn for -everal 
day-, until the patient i.- brought under the care 
of a medical officer. 

Acute Hepatitis 

Cause. — Caused by filterable virus of t wo t \ pes : 
( 1 ) SI I virus i serum hepatitis) (2) III virus (in- 
fection- hepatitis). The infection i- pa I from 

one person to another through contamination of 
foods or through breaks in the -kin. 

Symptoms. — Early, the patient may have 
trointe-t inal upset or oftentimes an upper respira- 
tory infection. Loss of appetite, chilliness, head- 
ache. Nausea and vomiting may occur, often- 
times diarrhea. Pain and tenderness <>f liver just 
below ribs margin on right side. Urine i- a dark 
brown color. Fever up t<> LOS F; however, some 
cases may be afebrile or have a temperature of less 
than loo i-'. Stools become light ami pasty. 
Jaundice often -ecu in the eve- and under the tip 
of the tongue. (Observe in daylight). General- 
ized jaundice may follow. 



106 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Treatment. — Preservation of liver tissue is the 
first consideration. Hospitalization is in order as 
soon as possible. Emergency treatment: 

1. Put to bed. Isolate if possible. Wash hands 
thoroughly each time after handling patient. 

2. Fat free diet with additional protein. (See 
diet for liver conditions). 

3. Fruit juices with sugar added. 

4. Multivitamin tablet twice daily. 

5. Avoid use of any drugs to prevent further 
liver damage. 

6. Care of excreta, cleaning of dishes, bedpans, 
and urinals should follow procedures set forth in 
isolation technique. 

7. Particular care must be exercised in the 
sterilization of all needles and syringes. The 
hepatitis virus is very resistant to many chemicals 
used for sterilizing. For this reason, only boiling 
or autoclaving of such equipment is acceptable. 

Acute Nephritis 

Cause. — Unknown. A predisposing cause is 
believed to be streptococcal infections, particu- 
larly of the respiratory tract. 

Symptoms. — Puffiness (edema) of the eyelids 
in the morning, of the ankles at night. Nausea, 
headache, blurred vision, spots before the eyes. 
Urinary characteristics : decreased amount, smoky 
in appearance, albumin, blood, casts, pus. Tem- 
perature up to 100° F. Pulse and respirations in- 
creased in proportion to fever. Occasionally pain 
is present in the flank. The patient appears 
acutely ill. 

Treatment. — 1. Hospitalize immediately. 

2. Handling of case until hospitalization is 
accomplished : 

a. Absolute bed rest. 

b. The diet is important. (Eefer to diet for 
nephritis) . 

3. Restrict fluids. 

4. Check the blood pressure daily. 

5. Keep track of fluid intake and urinary 
output. 

PEPTIC ULCER 

The Uncomplicated Ulcer 

Cause. — Unknown; however, it is associated 
with hyperchlorhydria of the stomach. Emotional 
factors seem to play a role. 



Symptoms. — Chronic pain in the epigastrium 
of a gnawing, burning nature, appearing at the 
same time and in the same place in relation to 
meals. May radiate to the back under the scapula. 
Pain is relieved by foods or other measures that 
neutralize acids. A tendency to experience dis- 
tention and discomfort often is an early symptom. 
Loss of weight may occur. 

Treatment. — 1. Hospitalization is not always 
necessary in mild cases, but a consultation with a 
medical officer should be requested. 

2. Diet is of greatest importance to reduce acid- 
ity and coat the ulcer. (Refer to "Peptic ulcer 
diet"). 

3. Aluminum hydroxide with magnesium trisil- 
icate 30 cc. may be given whenever necessary to 
neutralize acids. 

4. For the emotional patient small doses of 
phenobarbital, 14 to y 2 grain four times daily may 
be helpful. 

5. Cooperation of the patient is absolutely neces- 
sary for healing to take place. 

The Bleeding Ulcer 

Cause. — Bleeding is brought about by erosion 
of a blood vessel in the area of an ulcer. 

Symptoms. — Weakness, dizziness, fainting sen- 
sations. Patient's color pale and shallow. Tarry 
stools. Sometimes emesis of coffee grounds 
vomitus. A moderate fever. 

Treatment. — 1. Absolute bed rest. 

2. Morphine sulfate, y & to 14 grain, subcuta- 
neously. 

3. Nothing by mouth if patient is vomiting. 

4. If not vomiting, institute milk and cream diet. 
(See "Peptic ulcer diet"). 

5. Check blood pressure and pulse at frequent 
intervals. 

6. Check for further tarry stools or coffee 
grounds vomitus. 

7. Intravenous fluids such as plasma should not 
be given unless there is a drastic drop in blood 
pressure. Too sudden rise in blood pressure caused 
by such fluids may create further bleeding. 

8. Moderate fever is not an alarming feature. 
It is present due to absorption of toxins created. 

9. Hospitalize as soon as possible. 



FIRST AID AND EMERGENCY PROCEDURES 



107 



Pleurisy 
Cause. — Occurs most often as ;i complication to 

a primary chest condition, such as pneumonia or 
bronchitis. 

Symptoms. — Pain below the scapula or in the 
region of the tifth and sixth ribs directly under the 
arm. The pain is usually experienced when the 
patient coughs or inhale- and can range from a 
dull sensation to one of a sharp, stabbing nature. 
Temperature may he slight or as high as 10-1° F. 
The pulse rate rise- with the fever. Breathing 
most often is shallow to prevent pain and increases 
in rapidity with the rise in temperature. 

Treatment. — 1. Aspirin, in grains, or Aspirin, 
Phenaceiin and Caffeine Tablets 2, for pain PRN. 

2. Increased fluid intake. 

3. Adhesive straps may he applied to chest to 
relieve muscle spasm and pain. (See fractures 
for illustration of strapping chest ). 

4. If the patient does not respond to the above 
conservative treatment after a period of '_> 1 to 48 
hours and still has an elevation of temperature, 
he may receive either aureomycin, Chloromycetin, 
or terramycin in doses of 250 mg. every (i hours. 
Hospitalization or consultation should be re- 
quested as soon as possible. 

Respiratory Infections 

The common cold, bronchitis, pneumonia: 

Cause. — Most often a filtrable virus, although 
bacteria are sometime- the causative agents. 

Symptoms. — The severity of the symptoms will 
depend upon the disease present. Onset is more 
often gradual than sudden. Headache, malaise, 
chilliness, sore throat. A cough is invariably 
present in pneumonia and bronchitis. Pain in 
chest. Sputum — purulent in bronchitis, bloody 
in pneumonia. Elevated temperature, pulse, and 
respirations. 

Treatment. — 1. Bed rest. 

•_'. Isolation, if possible. 

:'>. Aspirin. 10 grains, as needed. 

I. Nose drops of 14-percent neosynephrine 
every t hours. 

■"'. Steam inhabit ions. 

6. Elixir terpin hydrate for cough. 

7. Force fluids. 

B. Easily digested foods. (See "Fever diet"). 



9. For Bevere conditions, such ae pneumonia, 

antibiotics are in order. If it is impossible to ad- 
mil BUCh a patient to a hospital immediately, the 

drugs of choice are aureomycin or chloromyi el in, 
500 1 1 1 tr. for the initial dose, and 250 mg. tbu 

after every 6 hours. Do not exceed a total of 
L2 grams. 

Rheumatic Fever 

Cause. — It is now widely believed that the 
hemolytic BtreptOCOCCUS plays an important patt 
in both the priinar\ a- well a- the recurrent 
attacks of rheiimat ic fever. 

Symptoms. — Often preceded by -ore throat or 
a cold, particularly of streptococcal origin. On- 
-et is often dramatic, though at time- it i- insidi- 
ous, and as BUCh, may run it- course unnoticed. 
One or more of the larger joint-. BUCh a- the 

shoulder or knee, bee e painfully swollen, red. 

and hot. These symptoms are often found to mi- 
grate from one joint to another. Fever -oine- 

times up to 104 F. The pulse ami respiratory 

rates increase in proportion to the fever. White 
blood count and sedimentation rate are increased. 

Patient's color i> often very pale, and he usually 

perspires quite profusely. 

Treatment. — If immediate transfer to a hos- 
pital is impossible, the following should be done: 

1. Absolute bed rest . 

2. Aspirin, or sodium salicylate, 1"> t<> 20 grains, 
three times daily after meal.-. 

3. For diet, refer to "Fever diet." 

4. Additional vitamin- may be given: fluids 
should be taken freely. 

5. For local relief of pain, application of oil of 
wintergreen and wrapping the affected joint are 
helpful. Pad- of cotton covered with gauze are 
applied to the painful area ami then held in pi 

by mean- of bandage. 

(>. Good nursing measures, such a- bed bath-. 

keeping the patient dry. supporting the affected 
joint, and guarding from chilling are very essen- 
tial 

7. Irregularities of the pulse beat and short 
of breath are da for possible heart 

damage Observe closely for this. 

Prognosis. — Unless there is heart damage, the 
patient usually recovers without further difficulty 

iii the com f several week-. With heart in- 
volvement, the prognosis i- greatly altered; for 



108 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



this reason, a patient who complains of joint 
pains, even though the pains are vague, should be 
observed closely for several days. Sedimentation 
rate, TPK should be taken for several days to 
determine if there are changes. It has been found 
that if a person who has had rheumatic fever later 
develops a sore throat or has a cold of streptococ- 
cal origin, there may be a recurrence of rheumatic 
fever. For this reason, a person giving a history 
of rheumatic fever should receive penicillin when 
symptoms of a sore throat develop. Such a pro- 
cedure will often prevent further development 
of rheumatic fever. 

Poliomyelitis 

Cause. — An acute infection, of a virus nature, 
which affects the nervous system, and may result 
in complete paralysis of various muscle groups. 
At times it occurs in serious epidemic form usually 
during the summer months, affecting children 
more frequently than adults. 

Symptoms. — In many cases the symptoms may 
be so mild that the illness is not noticed. They 
may disappear in 1 to 3 days and the individual 
not realize that he has been affected. Sudden on- 
set of fever periods, headache, sore throat, restless- 
ness, stiff back, stiff neck, spasms of various mus- 
cles, muscle pains, loss of reflexes, and paralysis. 

Treatment. — Any patient with the above symp- 
toms, especially sudden onset of fever — sore throat, 
who appears at the sick bay, during the summer 
months in an area where poliomyelitis is known 
to be present, or who, on questioning, has recently 
been in an area where it is known to exist, should 
be considered as a suspicious case until a medical 
officer has examined the case, or the symptoms 
have subsided for a period of several days. 

1. Isolate if possible. Isolate mess gear and 
linens. Use all precaution, especially wash hands 
well after handling. 

2. Complete bed rest. It has been demon- 
strated that those persons who continue physical 
activity after mild onset are more susceptible 
to paralysis than those who are placed completely 
at rest. 

3. "Watch closely for development of paralysis. 
Muscular spasms may be relieved by application 
of hot wet packs for 20 minutes, several times a 
day. 



4. Paralysis of throat and respiratory muscles 
are most dangerous. 

5. Bedboards may be helpful. 

6. If no other methods are available, be pre- 
pared to use artificial respiration, with teams for 
relief, if paralysis of respiratory muscles develop. 

7. Paralysis of throat muscles may require in- 
travenous administration of dextrose and saline 
solution. 

8. Radio for instructions if necessary. (See 
sample dispatch.) 

9. Get to a medical officer as quickly as possible. 

Spinal Meningitis (Cerebrospinal Fever) 

Cause. — By infection of the meninges with 
Neisseria intracellularis. Occurs at times in epi- 
demic proportions, especially in densely populated 
areas, usually in the winter and spring months. 
It is spread by droplet spray from nose and 
mouth. Carriers may be found at all times, es- 
pecially during epidemics. It is highly contagious. 
Symptoms. — Severe headache periods, projec- 
tile vomiting, high fever, rapidly developing con- 
fusion, delirium, coma and high WBC. Urinalysis 
will usually show albumin within 24 to 48 hours, 
with casts. In the early stages, moderate to se- 
vere pain will be caused when the head is raised 
from a pillow and moved as far forward as pos- 
sible, the legs raised from the hip will usually 
cause pain in the head, neck, and back. 

Treatment. — 1. Isolate if possible. Isolate 
mess gear and linens. Disinfect all excreta. Wear 
mask when attending patient. Wash hands thor- 
oughly each time. 

2. If vomiting prevents intake of fluids, intra- 
venous solution of 5 percent Dextrose and normal 
saline solution should be instituted. 

3. If oral medication is tolerated sulfadiazine, 
6 to 8 tablets (y 2 gram) initially followed by two 
tablets every 4 hours. 

4. If sulfadiazine is not available or not tol- 
erated orally, penicillin 50,000 units every 3 hours 
for 2 days. 

5. Light sedatives to help relieve pain and aid 
rest — phenobarbital, y 2 grain tid., or pentobarbi- 
tal sodium, 1/2 grain tid. Do not give morphine. 

6. Catheterization and enemas may be neces- 
sary. 



FIRST AID AND EMERGENCY PROCEDURES 



109 



7. ( lei under the care of a medical officer as soon 
as possible. 

Sen i:. — If ;i case breaks out on board ship it is ad\ laable 
thai ail personnel lie given 2 i" .". -ram- n( sulfadiazine 
dallj for 2 or :> days, or until a medical officer's advice Is 
available. 

ACUTE ABDOMINAL EMERGENCIES 

Appendicitis 

Cause. — An inflammatory process which is prob- 
ably brought about by a stopping up of the lumen 
of the appendix with fecal material. 

Symptoms. — Generalized abdominal pain which 
later localizes in the i • i ur 1 1 1 lower quadrant. Nau- 
sea and vomiting. Rebound tenderness. Often- 
times ;i desire to defecate without being able to 
do so. Slight elevation of temperature. Eleva- 
tion of WBC to over L0,Q00. 

Treatment. — (If it is impossible to get the 
patient to a Burgeon, the following conservative 
treatment is recommended.) 

1. Bed iest in preferably the semisitting posi- 
tion. 

•_'. Nothing by mouth. 

."). Insert Levin tube into stomach and attach to 
Wangensteen suction apparatus. 

4. Absolutely no laxat ive. 

:.. Penicillin (crystalline G) 100,000 units in- 
tramuscularly every •"> hours. 

6. Morphine, ' \ grain for relief of pain. 

7. Ice cap to abdomen if it makes the patient 
more comfortable. 

8. If Vomiting persists and the patient shows 
si^ns of dehydration, intravenous fluids of 5 per- 
cent dextrose in isotonic saline 1,000 CC. and 5 or 
10 percent dextrose in distilled water 2,000 CC. 
daily should be given intravenously. 

NOTE. — Never give morphine or penicillin if the patient 

is to l>e seen hy a doctor within '.\ to 4 hours time. 

Acute Gallbladder Disease 

Cause. — Manifestations primarily occur due to 
the presence of stones or infection of the gall 
bladder. The process that brings this about is 
often attributed to sluggishness of the gallbladder 
and a concentration of bile. 

Symptoms. — May have a sudden onset or be 
gradual, depending upon the existing causes and 



their severity. Colicky pain and tenderness in 
the upper right quadrant, accompanied by some 
muscle spasm. Referred pain to right shoulder. 
Distress an. I general feeling of fullness, particu 
larly after eating. If infection is present, toxic 
manifestations, such a- fever, will arise. 

Treatment.- -1. Hospitalize a- soon a- possible. 

•_'. Measures that ma) be instituted before hand: 

a. Put to bed in semi Fowler's po-ition. 

A. (Jive morphine, > , ; to ', grain, BUDCUta- 

neously. 

0. Avoid all fatty food- in the diet. (fl 

chapter on did-. | 

Hemorrhoids (Piles) 

Cause. — Hemorrhoids are usually produced 
either by pressure on or by an obstruction of the 
veins of the rectum, thus giving rise to either in- 
ternal or external hemorrhoids. 

Symptoms. — Internal hemorrhoids occur with- 
in the anal canal and ate not visible utile— they 

protrude, following straining. At such a time 
they appear outside t he anus in the form of -t raw- 
berry-colored masses. External hemorrhoid- are 
covered with skin and if thrombosed take on a 
bluish appearance and are very tender. Pain, 
itching, bleeding at stool, and protrusion when 
straining are the usual signs and s\ mptoms. 

Treatment. — 1. Surgery may become necessary. 
For much discomfort, a consultation is advisable. 

•2. Sitz hat 1 is- three times a day. 

3. Mild cathartic- to avoid constipation. 

4. ITi *rli roughage diet. 

5. Nupercainal ointment to the anus may give 
relief. 

Hernia 

Definition. — The protrusion of any one of the 
body organs from it* normal position. The ino-t 

con i type of hernia observed among military 

personnel is the inguinal hernia, meaning that a 
loop of the intestines has -lipped through the in- 
guinal canal and appear- in the groin or Bcrotum. 

Cause. (Inguinal) congenital and hereditary 
weaknesses play a large part. Injury, -train, such 
as lifting, or continued coughing are some of the 
exciting can 

Symptoms. — The reducible hernia: Dragging 
sensation in the abdomen and pain of a burning or 







HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



prickling nature. Upon examination a soft mass 
will be noticeable in the groin or scrotum. An 
impulse can usually be felt by having the patient 
in the standing position, placing the hand over 
the inguinal region and asking the patient to 
cough. The mass usually disappears when the 
patient lies down. 

The incarcerated hernia: The bowel becomes 
stuck in the hernial sac; the mass will not disap- 
pear when the patient lies down. The mass is 
tender and painful. Nausea and vomiting. The 
more severe the pain, nausea, and vomiting, the 
more acute the emergency. 

Treatment. — 1. The reducible hernia : This is 
not an emergency. See that the patient is given 
light duty and transfer him to a hospital as soon 
as it is convenient. Give scrotal support. 

2. The incarcerated hernia : 

a. This is a surgical emergency. Transfer to 
a hospital at once. 

b. If hospitalization will be delayed longer 
than 6 hours : 

(1) Nothing by mouth. 

(2) Morphine sulfate, *4 g rarn > f° r pain when- 
ever necessary. 

(3) Shock position. 

(4) Do not exert pressure on the mass. 

(5) For continued delay of transfer, insert 
Levin tube, attach to Wangensteen suction, and 
give 3,000 cc. fluids intravenously daily (1,000 cc. 
5 percent dextrose in isotonic saline, 2,000 cc. of 
5 or 10 percent dextrose in water) , penicillin (crys- 
talline G) 100,000 units intramuscularly every 3 
hours. 

Intestinal Obstruction 

Cause. — Causes are many. The most common 
are listed : Mechanical — Any mass, constriction, 
adhesion, or kink in the intestinal tract that pro- 
hibits the flow of the intestinal contents. Para- 
lytic — A reflex that sometimes accompanies ab- 
dominal operations or injuries. It may even be 
associated with severe infectious diseases, such as 
meningitis or pneumonia. Intestinal activity 
may be reduced to the point that it is almost com- 
pletely stopped. Vascular — A segment of the 
bowel is deprived of blood supply due to a throm- 
bosis in one of the mesenteric vessels. As a re- 
sult, activity in the affected bowel loop is stopped 
and the flow of intestinal contents is obstructed. 



Symptoms. — Vary according to the cause. The 
following are classical in the mechanical type of 
obstruction: Pain — Intermittent, colicky in na- 
ture, rises to a peak, and then stops suddenly. 
May or may not be generalized abdominal pain. 
Vomiting — May be projectile; stomach contents 
are seen first; later, intestinal materials of fecal- 
odor. Retching is usually present. Immediately 
after onset of symptoms, the patient may have 
several stools, sometimes of a diarrheal nature. 
After the distal end of the tract is emptied, con- 
stipation ensues. Abdominal distention. The 
patient's face is drawn, pulse is fast, often 
thready, and skin is cold and clammy. He looks 
and is violently ill. Dehydration follows quickly. 
Peristaltic sounds are high pitched and can often 
be heard without the aid of a stethoscope. 

Treatment. — This is a grave surgical emer- 
gency. Measures that may be instituted if hos- 
pitalization is delayed ai*e : 

1. Morphine sulfate, % grain q 4 h. 

2. Keep in semi-Fowler's position. 

3. Nothing by mouth. Insert a Levin tube into 
the stomach and attach to a Wangensteen suction. 

4. Penicillin G 100,000 units intramuscularly 
q3h. 

5. Keep a record of all output and give patient 
intravenous fluids including 1,000 cc. of isotonic 
saline in dextrose 5 to 10 percent. In addition, 
5 or 10 percent dextrose and also plasma should 
be given to combat dehydration and shock and 
to help meet caloric requirements of the body. 
Amino acids are also indicated if they are avail- 
able. 

Paronychia ("Run Arounds") (Felon) 

Cause. — Pyogenic infections around a finger- 
nail generally following tearing or cutting of the 
cuticle. 

Symptoms. — Redness and tenderness laterally 
to or completely around the fingernail. Accumu- 
lation of pus. 

Treatment. — 1. Hot 4 percent boric acid soaks 
for 15 minutes, four times a clay. 

2. Sulfadiazine, 15 grains every 4 hours if the 
condition aj^pears acute. Be sure to force fluids. 

3. If incision and drainage appear to be neces- 
sary, the patient should be referred to a medical 
officer. Incision on any part of the hand should 
never be performed by anyone except a surgeon. 



FIRST AID AND EMERGENCY PROCEDURES 



111 



Perforated Peptic Ulcer 

Cause. — (See "'Peptic ulcer.") The ulceration 
of the stomach or duodenum proceeds to such an 
extent that it goes completely through the muscu- 
lature. An ulcer history may <>r may not precede 
this occurrence. 

Symptoms. — Pain — sudden, excruciating, burn- 
ing pain, generally on the right side, created by 
stomach juices flowing into the peritoneal cavity. 
The abdominal muscles quickly become axed and 
arc boardlike. The patient is drenched with pers- 
piration, his breathing is very shallow, he moans 
deeply, and he lies motionless. Shock follows 
quickly. The temperature at first is subnormal; 
then it will rise. Pulse and blood pressure may be 
normal at first ; then it will change to fit the picture 
of shock. 

Treatment. — A grave surgical emergency. 
Measures that may be instituted before surgery 
are : 

1. Morphine sulfate, 14 grain, subcutancously 
q 4 h. 

•1. Nothing by mouth. Insert a Levin tube into 
the stomach ami attach to a Wangensteen suction. 
If suction apparatus cannot be set up, keep aspirat- 
ing stomach contents with large syringe. 

:'.. Complete rest in semi-Fowler's position. 

4. Intravenous 5- or lO-perceni dextrose in iso- 
tonic saline 1.000 ec. Over the 2 1-hour period -2,000 
rr. additional Quids in the form of .V or 10-percent 
dextrose in distilled water may be given. 

:>. Penicillin (crystalline G) 100,000 units in- 
tramuscularly every ."> hours. 

Pilonidal Cysts 

Definition. — A congenital cyst found at the base 
of the spine. 

Cause. — Believed to be formed during embry- 
onic life from cells of hail' and glandular ti>sues. 

Symptoms. — May be unnoticed until a sinus 
forms and drainage occurs. The sinus is generally 
in midline between the coccyx and the anus. 
Drainage and oftentimes infection, occur fre- 
quently in connection with repeated jolting and 
bruising of the coccygeal area.- 

Treatment.— 1. Hospitalization should bo 
granted for drainage or excision. 

2. Hot wet packs or Sit/, baths three or four 
times a day may lie helpful in relieving pain and 
congestion. 



DISEASES OF THE SKIN 
General Points To Remember in Treatment of 

Eczematoiu Skin Conditions 

(This group include- poison ivy, nummulai 
zema, fmiL r u- infections, chronic vesicular erup- 
tion- of hand- and feei. contact dermatitis, etc) 

1. Do not overt reat. Medications which . 

a burning Bensal ion or increased itching are to be 
avoided. 

2. In general, t real according to the appearance 

of the loioi 

Acute dermatosis (redness, weeping', blisters, 
swelling, and crusting). Cool wet dressings are 
indicated. Boric acid solution 2-percent, Bur- 
row's solution 1:20, potassium permanganate 

] : 10,111)0, or normal -alt BOlution may Ih> used a- 
a -oak or as wet dressing id re — inL r - mu.-t be kept 
wet with solution ) continuously or intermittently. 
depending upon acutenese of eruptions and pa- 
tient's distress. 

Subacute dermatosis (redness without weep- 
ing and blisters; scaling may be present). Cala- 
mine lot ion or calamine liniment to which may be 

added '..percent phenol is l>e-t. If scaling is 
present, mild ointment- or pastes may be used 
boric acid ointment, zinc oxide ointment, or zinc 
oxide paste. 

Chronic dermatosis 1 little redness, much scal- 
ing, leathery thickening of the skin). Here oint- 
ments are indicated-boric a. id ointment, zinc 
oxide ointment, coal tar ointment 1 to .'. percent. 
Whitfield's ointment 1 , or ' _. percent, or viofonn 
ointment •"> percent. 

Widespread eruptions are best treated with 
lotions or liniment-. 

•"». Pyribenzamine. 50 mg., or henadryl. 50 ihl'.. 
four times a day may be L'iven by mouth for itch- 
ing. 

1. Do not use penicillin or sulfi preparations 
locally a- a severe reaction may result due t 
allergy being present. If the skin disease i- due 

to infection, these drugs are m tfl a hen 

given systemically. 

Acne Vulgaris 
Cause. Usually appears at puberty. The] 

ence of acne ha- been attributed to an unbalai 

the BOX hormones. Other factor.-, Mich as DOOr 

hygiene and diet, play a part 



112 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Symptoms. — Papules, pustules, and/or cysts on 
the face, and oftentimes the shoulders, chest, and 
back. Presence of blackheads. Oiliness of the 
skin and scalp. 

Treatment. — 1. Scrub the affected areas three 
to six times daily with soap and warm water. 
This is particularly important at bedtime. 

2. A sulfur lotion or the medication prescribed 
by a medical officer should be applied nightly. 

3. The scalp must be kept clean by washing 
twice a week. 

4. The lesions should not be picked or squeezed. 
Blackheads may be removed several times a week 
with a blackhead extractor. 

5. The following foods should be avoided : fats, 
cheese, nuts, chocolate, pastries, alcohol, seafood, 
and ice cream. 

6. Adequate sleep, 8 hours a day. 

7. Any systemic conditions, such as infections, 
bad teeth, constipation, should be corrected 

8. The patient should avoid excessive heat and 
exposure to grease and oils. Ointments and creams 
should not be used for shaving or as a part of the 
treatment. 

9. Sunbathing or ultraviolet lamp treatments 
in erythema doses are both of benefit. 

10. The patient must be warned against be- 
coming impatient. The treatment must be con- 
tinued over a long period of time, and resistant 
cases should be referred for consultation. 

11. The following lotion will be satisfactory 
for the average patient: 

Eesorcin 3.6 gm. 
Precipitated sulfur 9.6 gm. 
Zinc oxide 15.0 gm. 
Glycerine 12.0 gm. 
Alcohol 50 percent q. s. 120 cc. 

Dermatophytosis (Fungus Infections) 

There are a number of fungus infections of the 
skin and hair, but the two most common types are 
tinea cruris (jock itch) and tinea pedis (athlete's 
foot) . 

Cause. — A fungus which grows in the most su- 
perficial layer of the skin and can be demon- 
strated under the microscope. 



Tinea Cruris (Jock Itch) 

Symptoms. — Area of redness in the groin which 
may be weeping or scaling and is outlined by a 
border which is raised and shows small blisters. 

Treatment. — 1. If acute, put the patient to bed 
and use only wet dressings. 

2. When subacute, apply fungicidal powder 
night and day. 

3. When chronic, apply fungicidal powder dur- 
ing the day and fungicidal compound ointment at 
night. 

4. Treat the feet because they are usually the 
focus. 

Tinea Pedis (Athlete's Foot) 

Symptoms. — Skin eruption involving both feet 
and invariably the skin beneath and between the 
toes. Other areas of the foot may also be involved 
in addition to the toes. If acute, will show blis- 
ters, weeping redness, and sometimes secondary 
infection. If chronic, will show scaling and crack- 
ing about the toes and other involved areas. 

Treatment. — 1. If acute, use potassium perman- 
ganate 1 : 10,000 as wet dressings or soaks and put 
the patient at rest. 

2. When subacute, continue soaks three or four 
times a day and use fungicidal powder between 
soaks. 

3. When chronic, use fungicidal ointment night- 
ly and fungicidal powder during the day. 

Note. — Vesicular, weeping, and sealing eruptions of the 
feet which do not involve the toes, webs, and folds are 
usually not fungus infections. Vesicular, weeping, and 
scaling eruptions which involve both hands are usually 
not fungus infections. 

Pediculosis 

Cause. — By lice and is most frequently observed 
in parts of the body covered with hair. 

Pediculosis Capitis 

Symptoms. — Itching of the scalp. Presence of 
nits (eggs), especially behind the ears. The louse 
can be observed in the hair. A skin eruption may 
be present along the hair line of the neck. 

Treatment. — 1. Apply 10 percent DDT powder 
to the hair and scalp thickly and allow it to remain 
for 24 hours. Cover head with tight-fitting cap 
or bandage. 



FIRST AID AND EMERGENCY PROCEDURES 



113 



2. Shampoo the hair thoroughly. 
:'>. Repeal the above treatment on the fourth 
:i!nl eighth day after the first treatment. 

Pediculosis Pubis 

Symptoms. — Intense and persistent itching of 
the pubic area and oftentimes the axillae. Pres- 
ence of nits on hair and presence of the louse. 

Irritation of the skin can usually be noted in the 
affected area. One may also find nits and lice in 
eyebrows and or eyelashes. 

Treatment. — 1. All affected areas must bo 
t reated to prevenl recurrence. 

•J. Apply 10 percent DDT powder. After -J I 

hours, the person should bathe, being sure to pro- 
duce a thick lather. Repeal the treatment as 
above in four and eight days. 

■".. for treatment of the eyes and eyelashes, re- 
move nits and lice very carefully with a small 
forceps and apply 1 percent mercury ophthalmic 
ointment or y 2 percent ammoniated mercury oint- 
ment. 

Prickly Heat or Heat Rash 

Cause. — Excessive sweating as a result of ex- 
posure to heat. 

Symptoms. — Red papules on covered portions 

of the body. Marked itching. 

Treatment. — 1. Lightweight clothing should 
be worn. 

2. Avoid soap to involved areas of .skin and clean 
these areas with starch water daily. 

3. To relieve itching, patient may use a dusting 
powder or calamine lot ion with 'J percent resorcin. 

4. Sunbaths are often helpful. 

•V Severe cases should he removed from duty 
until cleared. 

Scabies (The Itch) 

Cause. — Scabies mite. History of direct con- 
tact with another infected person or of other mem- 
bers <d the family itching. 

Symptoms.— Presence of small zi«r/ajr tracks 
(burrows) in the form of elevated pathways with 
vesicles at one end. These are best seen between 
the fingers and on the wrists. Skin lesions are 
commonly found between fingers, on wrists, above 
the elbows, about the axillary folds, about the 
umbilicus, on the genitalia, and on the buttoi 



The face, scalp, le;_ r -. and feet are raiel\ involved 

except in infants. Etching is most severest night. 
Treatment. — 1. Attempt to find all contacts and 
treat. 

•_'. Instruct the patient to take a hot shower, 
u-iii" a thick lather of soap. 

3. Appk Crotamiton (Eurax) to the entire 
body from the neck down to the ankle-, being sure 

to include arm-, forearm-, and hand-. 

I. Allow the patient to wear clean pa jama- : iso- 
late and '_' I hours later reapply the ( H it a in it on to 
the entire bodj I no hath I. 

.. Twenty four hours after the second applica- 
tion, the patient should take a hot shower and then 

put on clean .lot king. 

6. All clothing he ha- previously worn must U* 

laundered Or dry cleaned. This also applie- to 

bedding. 

7. Another formula that may be used in the 

same manner a- t he ( 'rotamiton is Kwell. 

THE PYODERMAS 

Skin conditions caused by the Streptococcus or 
Staphylococcus, separately or together. 

Folliculitis. — Inllamniat ion of the hair follicles. 

Symptoms. — Pustule- around the hair follicle, 
most often seen on the face. The lesion- may be 
single or grouped, and if on the fa.,-, eft en appear 
first about the upper lip. Most often found 

among those who work with grease, oil. tar. or 
irritating chemicals. 

Treatment. — 1. Cleanliness of the -kin i- fore- 
most in importance. The patient should wa-h the 
area thoroughly each morning; then he should 
manually pull out the affected hair-. 

•J. Follow with hot wet die— in<_' for at least 1 ."> 

minutes. 

:',. Apply an ointment. BUcb a- :'. to 5 percent 
ammoniated mercury or :'> percent vioform. and 
then lather the area thoroughly and -have. A tier 
shaving, reapply the ointment. 

4. The ointment should be applied several more 
times during the day and before going to Led. 

.'>. The razor should l*> sterilized after shaving 
and a clean blade used daily. 

<;. Consultation should he requested if no im- 
provement OCCU] -. 






114 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Impetigo Contagiosa 

Symptoms. — Appearance of honey colored 
crusted lesions that are sharply defined. There 
may be several lesions or only one, but spreading 
usually is rapid. Generally found on the face or 
neck. Itching may or may not be present. 

Treatment. — 1. Exercise care in preventing a 
spread to others. Equipment for washing and 
bathing should be held separate until the lesions 
are cured. 

2. The crust must be removed completely with 
boric acid compresses, hydrogen peroxide, or soap 
and water three times a day. 

3. After the crust is completely removed, apply 
5 percent ammoniated mercury or 3 percent vio- 
f orm ointment and rub rather vigorously into the 
area. 

4. If the lesions are in the bearded area, the 
patient should shave daily, using a clean blade and 
a razor which has been sterilized by boiling. 

Note. — For treatment of furuncles — carbuncles refer to 
"Wounds." 

NEUROLOGICAL CONDITIONS 

Convulsions 

Cause. — Convulsive attacks are not considered 
to be a disease but rather symptoms of a disturb- 
ance of the central nervous system. They range 
from petit mal attacks which are very brief and 
fleeting and do not cause unconsciousness of the 
patient to grand mal seizures in which there is 
complete loss of consciousness. 

Symptoms. — Grand mal : The patient may have 
a warning "aura." This warning can appear in 
any form, such as a bright flash of light or a pecu- 
liar feeling in the epigastrium. He may utter a 
cry. He then falls to the deck, unconscious and 
rigid. He may be apneic and cyanotic. This is 
the "tonic" phase of the seizure. Coarse tremors 
quickly follow that generally involve the entire 
body. This is the "clonic" phase of the seizure. 
The patient may froth at the mouth, bite his 
tongue, and become incontinent. Gradually con- 
sciousness returns and the patient appears con- 
fused and disoriented. Drowsiness and a desire 
to sleep follow ; the patient may have a headache. 

Treatment. — Hospitalization is indicated ; how- 
ever, as a general rule, this is not an emergency 



unless the patient has repeated attacks at close 
intervals. 

1. Have the person removed to sick bay where 
he can be observed. 

2. Bed rest following an attack usually is not 
required but should be granted if deemed neces- 
sary. 

3. During the seizure: 

a. Keep the patient from hurting himself. 

b. Turn him on his side so that mucus can flow 
from mouth and throat. 

c. Place tongue depressors, spoon handle, or 
some other firm object between the teeth to pre- 
vent biting of the tongue. 

d. Do not restrain; only protect. 

4. After the convulsion: 

a. Give phenobarbital, 14 to y 2 grain, three 
times a day. 

b. Make sure that he has a lower bunk ; better 
still, allow him to sleep on a matress that has 
been placed on the deck. 

c. Kecord accurately all that was observed — • 
the manner in which the convulsion spread over 
the body, approximately how long it lasted, and 
any accompanying episodes that were witnessed. 
Make a note of any situations, such as excesses 
of caffeine, tobacco, or emotional tension, that 
might have a bearing on the seizure. 

5. If a medical officer is not available, a person 
who has convulsions in rapid succession may be 
given sodium amytal, 3 to 7!/2 grains, intrave- 
nously and very slowly to help prevent further 
attacks. 

Headaches 

Cause and symptoms. — Tension due to emo- 
tional conflict usually involves the entire cranium. 
Sinusitis — involving the frontal and maxillary 
areas and oftentimes accompanying a cold. Eye 
strain — reading in poor light; need of glasses. 
High blood pressure — due to great tension of the 
blood vessels. Any toxic condition such as may 
be brought about by viruses, bacteria, or constipa- 
tion. Increased intracranial pressure — brought 
about by any space-taking lesion in the brain. 
Migraine — thought to be a circulatory disturbance 
in the brain that causes intense pain that is usu- 
ally unilateral, nausea, vomiting, followed by 
fatigue, and oftentimes depression. 



FIRST AID AND EMERGENCY PROCEDURES 



115 



Treatment. — 1. Attempt to determine the 
cause. 
2. Mild analgesics, such ;•- aspirin, 10 grains; 

in severe cases, such as sinusitis, codeine, » '.. grain 

may be given with aspirin. 

8. Persistent headaches thai are accompanied 
by systemic involvement should be referred to a 
medical officer at the first opportunity. 

Intracranial Injuries 

Foreword. — Intracranial injuries can occur in 
varying degrees. The damage done to the brain 

tissue is the serious issue. Regardless of the type 
of injury, he it a concussion, hemorrhage, or frac- 
ture, certain observations should he made and 
treatments instituted. 

Symptoms. — Develop in relation to the severity 
of the condition. Blood pres>mv -Systolic pres- 
sure rises. Diastolic rises also but not as fast : 
therefore an increase occurs in pulse pressure. 
The pulse rate slows down, oftentimes to GO or 
helow. It is generally a heavy, full pulse. Res- 
pirations are slower; in severe conditions they are 
of the Cheyne-Stokes type. The temperature 
generally rises. The level of consciousness may 
vary and should he observed. If the patient is 
conscious he complains of headache which is ag- 
gravated by bending forward, by coughing, by 
straining at stool, etc. Pupils may be unequal in 
si/.e; sometimes there is unusual eye movement. 
Grimacing, paralysis, and convulsive movements 
should he watched Cor. Reflexes are generally in- 
creased on the side opposite to the one affected. 
Observe patient for scalp lacerations, contusions, 
or leaking of fluid, especially from nose or ears. 

Treatment (this holds true for the unconscious 
patient in general). — 1. Keep the patient's air- 
way open. Keep the mouth, nose, and throat free 
of mucus, blood, and vomit us by Miction. A large 
syringe and small rubber catheter may he used. 
If you are sure the patient has no spinal injury, 
turn him on his Bide. 

2. Stop any gross bleeding; use pressure band- 
ages or hemostats if necessary. . 

:'.. Take the blood pressure, temperature, pulse. 

and respirations and record. 

4. Catheteri/.e the patient and save the speci- 
men. Strap the catheter in place. Keep a rec- 
ord of the output. 



I Observe the following and record : 

ii. Note any eye changes, dilation ol pupils, 
unusual eye movement. 

b. Note any convulsive movement-, facial 
grimacing, jerking. 

Note the level of consciousness ; thai 

whether the patient IS Conscious, Stuporous, irra- 
t ional, combative, comatose 

</. Look for paralysis of the. limbs, 1 '• 
mine by pinching or pricking with pin. 

6. Start intravenous fluids of •"> percent dex- 
trose in water. Fluids should lie restricted some- 
what, hut dehydration mu.-t be avoided — 1,500 oc, 
daily is about average intake. 

7. If possible, do a urinalysis (look for Bugar 
and blood particularly) and GBC. 

8. Give tetanus toxoid if injury i- present. 

9. Shave widely around any lacerations and 
cleanse thoroughly by irrigating with sterile nor- 
mal Baline under low pressure and apply drj sterile 
dressing. 

10. Temperature rectally every hour. If the 
temperature reaches 103 P. or over, remove cloth- 
ing and give continuous body sponges with al- 
cohol. 

11. Continue suctioning throat frequently. If 
spinal fluid is leaking from the QOSe, do not mic- 
tion the nose. (The patient should not l>e al- 
lowed to blow his nose if he is conscious. ) 

12. Turn from side to Bide every hour. 

13. For uncontrollable restlessness, give paral- 
dehyde 1 cc. deep into the gluteal muscle when- 
ever necessary. Never give narcotics. 

14. Continue taking and recording pulse, res- 
pirations, and blood pressure every 1"> to 30 min- 
utes. 

L5. Penicillin (crystalline G) 100,000 units in- 
tramuscularly every •"» hours if the patient has 
lacerations and fractun 

Spinal Cord Injuries 

Foreword. — Spinal cord injuries are usually 
caused by fracture of the vertebral column, gun- 
shot wounds, or stah-. In any injury of this type 
proper care is of the most importance. ( Observing 

the patient for injury to the vi-.eia must not be 
Overlooked. One who presents the picture of 
shock usually ha- a deeper, accompanying injury. 

Symptoms. — Aside from the pi* of a 

wound one should note wheth er the patient can 



IHF0RMATI0H £ 
U.S. 



PICE 



116 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



move one or both feet, Note whether he appre- 
ciates painful stimuli, such as a pin prick to the 
lower extremities. Look for gross injury to the 
spine. 

Treatment. — 1. If shock is present that must 
be treated first. 

2. Do not move the patient until you have a 
sufficient number of men available. 

3. Do not twist the body or allow it to bend; 
keep the head aligned with the body. 

4. A fracture board should be improvised and 
slipped under the mattress of the bunk. 

5. The patient may have to be catheterized. 
Scrupulous technique must be used; tape the 
catheter in place. 

6. Good nursing care is of great importance. 
Decubitus ulcers form rapidly. 

7. Keep the possibility of meningitis in mind. 
Start penicillin (crystalline G) 100,000 units q 3 h. 

8. Transfer to a hospital as quickly as possible. 

9. See fracture of spine, First Aid and Emer- 
gency procedures. 

GENITO-URINARY CONDITIONS 
(The Kidneys and Ureters) 
Renal Colic (Renal Calculus) 

Cause. — Generally brought about by stones but 
may occur due to any substance that blocks the 
flow of urine ; e. g., blood clots. 

Symptoms. — Pain — onset is usually sudden. 
Begins in loin of the affected side ; and as the stone 
descends in the ureter, the pain begins to radiate 
downward and forward into the thigh and testi- 
cles or sometimes down the back of the thigh. 
Nausea and vomiting often present ; also profuse 
perspiration. Eigidity of the muscles in the loin 
of the affected side. Oftentimes abdominal dis- 
tention occurs. Urinary findings are red blood 
cells, albumin, and white blood cells if infection is 
also present. Obtain past history of such attacks, 
operations performed. 

Treatment. — 1. Put to bed; give morphine sul- 
fate, y e to y^ grain, for relief of pain. Atropine, 
y 150 grain, may also be given to relieve spasm. 

2. Nothing by mouth until vomiting subsides. 

3. Prevent dehydration. Give intravenous 
fluids of 5 percent dextrose in water if necessary. 

4. Check the urinary output conscientiously. 
Strain all urine and watch for stones. 



5. For distention use rectal tube, heat to abdo- 
men, enemas. 

6. Transfer the patient to a hospital as soon as 
possible. 

Pyelonephritis 

Cause. — Infection of the renal pelvis and paren- 
chyma. B. coli is the most common offender. 

Symptoms. — Sudden onset with chills and 
fever. Dull aching pain in the kidney involved ; 
also tenderness. Frequency, urgency, and dis- 
comfort on urination. Urinalysis shows pus, al- 
bumin, and possibly red blood cells. Abdominal 
distention is not uncommon. White blood count 
may be elevated. 

Treatment. — 1. Put to bed. 

2. Penicillin (crystalline G) 100,000 units in- 
tramuscularly every 3 hours. In severe cases give 
sulfadiazine and soda bicarbonate, 15 grains of 
each every 4 hours in addition to penicillin. When 
giving sulfa drugs, force fluids. 

3. Diet as tolerated. 

4. Mild sedation if needed. 

5. For abdominal distention, rectal tube, heat to 
the abdomen, enema. 

Kidney Injury 

Cause. — History of injury either due to a fall 
or a blow in the back in the region of the lower 
ribs. 

Symptoms. — Pain in the loin. Blood in the 
urine, oftentimes in the form of clots (thread-like 
in shape, formed in the ureter). The loin should 
be palpated. If a growing, tender mass is felt, 
it is generally due to an escape of blood into the 
area surrounding the kidney. Shock and signs 
of hemorrhage in the more severe cases. 

Treatment. — 1. For shock, start plasma and 
give morphine sulfate subcutaneously for pain. 

2. Start penicillin (crystalline G) 100,000 unite 
intramuscularly every 3 hours. 

3. Observe the patient closely. If injury is not 
severe, the following picture usually presents it- 
self in 12 to 24 hours : 

a. Temperature does not rise. 

b. Discomfort does not increase. 

c. No further swelling in the loin is noted. 

d. Some blood may still be in the urine. 

e. Blood pressure and pulse remain or become 
normal. 



FIRST AID AND EMERGENCY PROCEDURES 



117 



4. In Bevere injuries. surgical treatment is in- 
dicated. The following picture usually presents 

itself in 12 to 24 hours : 
a. Increase of pain. 

l>. Discoloration of the Hank; enlarging mass. 
o. Evidence of extravasation of urine into the 
Hank. 

d. Continued bloody urine with clots. 

e. Appearance of toxic si«rns, such as rise in 
temperature. 

/. Signs of blood loss, such as shock with fall- 
ing blood pressure, rapid weak pulse, palor, cold 
clammy skin. 

LOWER URINARY TRACT (BLADDER, 
URETHRA, AND GENITALIA) 

Bladder Injuries 

Cause. — Bone spicule or foreign body, such as 
shrapnel or a bullet, enters bladder. Frank rup- 
ture due to crushing injuries; oftentimes found 
to accompany fracture of the pelvis. 

Contributing causes. — A full or overly dis- 
tended bladder. Numbing from excessive intake 
of alcohol which in turn permits an overly dis- 
tended bladder. 

Symptoms. — A desire to urinate almost con- 
stantly without relief. Hematuria. Failure to 
obtain clear urine via catheter, usually only a few 
cubic centimeters of bloody urine. Pain in lower 
abdomen. Extravasation of urine into the sur- 
rounding tissues, which rapidly develops into 
infection. 

Treatment. — 1. A grave emergency. Requires 
surgical treatment within 24 hours. 

2. Treat the shock; relieve the pain. 

3. Put a retention catheter in place if possible. 

4. Start penicillin (crystalline G) 100,000 units 
intramuscularly. 

Injuries to the External Genitalia (Straddle 
Injuries, Contusion of the Genitalia) 

Cause. — History of blow or fall, resulting in 
direct injury to the genitalia. 

Symptoms. — (Will vary in relation to severity 
of the injury). Shock and intense pain: the pa- 
tient is usually writhing. Hemorrhage may 

211866*— 53 9 



occur: hematuria. A desire to void without be 
able to do so. A hematoma often develops i ipidly. 
Fever and infection may develop later. 
Treatment. 1. Morphine sulfate, ',, to 'i 

grain, for pain. 

2. immediately attempt to pass a catheter. It 
successful, Becure by means of adhesive Btrips. 

3. Treat the shock. 

4. Begin penicillin (crystalline G) L00, units 

intramuscularly. 

... [ce to the Injured part, particularly in the 
case of contusion. 

6. Elevate the genitalia. This may be accom- 
plished by a thickly folded towel, or by 088 <>f 
adhesive bridge from thigh to thigh. 

in any severe injury to the urethra <>r genitalia, 
when it becomes Impossible to Insert ■ catheter, bladder 
distention must Dot be allowed f • • p ro gra m '" tin- |M.int 
thai the bladder will rupture, if medical help does not 
become available within t<> t<> l- boon and r i > * - bladder 
is rising Into the abdominal cavity, 1 1 1» - foUowlng may 
then he clone as an emergency measure: 

1. In midline, about - J inches above the sym- 
physis pubis, shave, cleanse, and apply an 
antiseptic. 

2. Infiltrate the area with ' j or 1 percent pro- 
caine. ( See •'Anesthesia.") 

3. Insert a No. 1<> or 17 needle and allow enough 
urine to flow out to give the patient relief and 
diminish the intra bladder pressure 

4. Do not empty the bladder completely. In a 

greatly distended bladder, not more than 600 to 

600 CC. should be allowed to How out. 

5. After release of urine remove the needle and 
apply a dry. sterile dressing to the area. 

Epididymitis 

Cause. — Infection, often of DOU venereal origin, 

straining, lifting with a full bladder. 

Symptoms. — Tain, tenderness, and a slightly 
irregular mass at the testicle, pain in groin. 

Fever, nausea, malaise. Inflammation of the 
Scrotal wall and skin. Careful palpation will 
veal an area of maximum tenderness ami indura- 
tion behind the te-ticle in the epididymis. 

Treatment. — 1. Elevation of the scrotum. 

•j. Hot or cold compn ontinuotisly 

whichever gives patient most relief). 
for pain. 



118 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



4. Penicillin (crystalline G) 100,000 units in- 
tramuscularly every 3 hours or streptomycin, 0.5 
gm., q 6 h. 

5. Hospitalize. 

Phimosis 

Cause. — May be congenital or acquired. In the 
latter situation, inflammation, unclean habits, or 
trauma may be predisposing factors. 

Symptoms. — Inability to retract the prepuce 
over the glans. The orifice is generally small in 
relation to the size of the glans. 

Treatment in presence of active inflamma- 
tion. — 1. Hot saline soaks. 

2. Cleansing under foreskin with irrigations of 
a mild antiseptic. 

3. Hospitalize for circumcision. 

Paraphimosis 

Cause. — A certain degree of phimosis and pro- 
longed retraction of this tight foreskin, held in 
the sulcus behind the glans penis. The prepuce 
margin forms a constriction there, which strangu- 
lates as edema develops. 

Symptoms. — Swelling, edema, and discolor- 
ation on the glans develop rather quickly and are 
accompanied by considerable pain. 

Treatment. — 1. Elevation — ice bag in early 
stage. 

2. Manual manipulation (to reduce swelling 
by direct pressure and draw forward the constrict- 
ing foreskin from behind the glans) . 

3. If the condition is too far advanced, cut this 
constricting portion (novocaine 1 percent locally 
infiltrated). 

4. Circumcision at later date when reaction 
subsides. 

Balanitis 

Cause. — Due to retention of irritating mate- 
rials under the prepuce, thus bringing about an 
inflammation of the glans. TJncleanliness is the 
outstanding factor, plus a redundant prepuce. 

Symptoms. — Glans and prepuce red and moist. 
Swelling and pain. Itching sensation. Foul- 
smelling secretions. 

Treatment in active inflammation. — 1. Hot 
saline soaks or potassium permanganate 1 : 10000. 

2. Cleansing irrigations under foreskin. 



3. Circumcision when active inflammation sub- 
sides. 

4. If unable to cleanse under prepuce and in- 
flammation progresses or fails to respond, make 
a dorsal slit and expose the glans to permit effec- 
tive local cleansing and soaks. 

5. Antibiotics if associated with severe inflam- 
mation and fever. 

EYE, EAR, NOSE, AND THROAT 

The Eye 

General points to keep in mind concerning eye 
examinations. — 1. Before treating a new patient's 
eye, always determine his approximate visual 
acuity and record same. If an eye chart is not 
available, one should be improvised. 

2. A good light must be at hand. 

3. A magnifying glass or Beebe Binocular 
Loupe should be used if available. 

4. The patient should be seated with his head 
braced. 

5. To examine the eye, have the patient look up 
while the lower lid is being pulled down. Have 
the patient look down ; pull the upper lid straight 
out by placing the thumb under the upper eye- 
lashes and the index finger on top of the lid. 
Evert the upper lid. 

6. When using any type of instrument on the 
eye, such as an applicator or medicine dropper, 
the operator must rest his hand on the patient's 
head. 

7. For the patient who is unable to cooperate, 
instill a drop of one-half or 1 percent pontocaine 
into the eye before continuing. 

8. Any time the cornea is affected, consider the 
condition serious and send the patient to a doctor. 

EYE CONDITIONS 

Conjunctivitis 

Cause. — Bacterial infection of the conjunctiva. 

Symptoms. — Redness of the sclera. Pus pres- 
ent in the eye. Burning sensation. 

Treatment. — 1. To gain the patient's coopera- 
tion, put 1 drop of one-half or 1 percent ponto- 
caine into the eye. 



FIRST AID AND EMERGENCY PROCEDURES 



119 



2. Four times daily, irrigate the eye, with 2 per- 
cent boric Mi-id solution and apply bot comprt 
then apply an antibiotic ointment. 

3. The patient should wear B patch over the 

eye and be seen by a doctor as booh as possible. 

Iritis 

Cause. — Bacterial infection of the iris. 

Symptoms. — Redness around and over the iris. 
The eye waters. Usually intense pain. 

Treatment. — 1. Pantocaine one-half or one per- 
cent ( 1 drop in the eve) or 1 percent atropine 
ointment to the eve. 

2. Put patch over the eye and send to the hos- 
pital at once. 

Styes 

Cause. — A bacterial infection of the glands of 
the eyelids. 

Symptoms. — Localized swelling and redness of 
the eyelid. 

Treatment. — 1. Apply hot compresses every 3 
hours. 

2. When pus appears and the stye becomes fluc- 
tuant, gentle pressure may be used to release the 
exudate. 

3. Irrigate the eye with 2 percent boric acid 
solution. 

Flash Burns 

Symptoms. — Ent i re eye is red. Symptoms may 
not develop until a day or two after exposure. 

Treatment. — 1. Irrigate the eye with warm 
normal saline, apply atropine ointment or butyn, 
and cover. 

2. If there is visual loss, the patient should be 
seen by a doctor. 

THE EAR 

External Ear Infection 

Cause. — Usually bacteria resulting in cellulitis, 
sometimes fungus. 

Symptoms. — At first, itching, and feeling of 

fullness in the ear. then pain. The patient ex- 
periences acute pain when pressure is exerted on 
the tragus, or the auricle of the ear is moved. A 
discharge may be present and is normally of a 
serious nature. When one attempts to observe 



the ear drum with an otoscope, the canal is often 
found to be closed due t<> swelling. 

Treatment. — 1. Reduce the swelling by soak- 
ing a narrow strip i about one fourth inch wide) 
of fine nioli gau/e in warm '< percent BuiTC 

solution ami Insert this into the ear. Pour times 
daily resaturate the gauze wick by putting aevei 
al drops of warm Burrow's solution into the ear. 
Reinsert a fresh wick daily. Four pencnt boric 

acid solution may be u-ed if BuTTOw'fl i- not avail 
able. 

2. Give penicillin (crystalline <»> 50,000 unit- 
intramuscularly every •"» hours if the patient has 
fever. 

".. Aspirin, 10 grains, and codeine, * L . grain, for 
pain. 

1. After swelling subsides, keep the ear clean 
and dry by using cotton applicators. 

5. Warn the patient against swimming. Tell 
him that while he i.- taking a shower he should pat 
cotton plugs in hi.- ear-. 

6. Keeping the ear clean and dry i- the most 
beneficial treatment. Avoid the u-e of irritating 
substances; e. g.. alcohol, cre-atin. 

Otitis Media (Middle Ear Infection) 

Cause. — The patient will usually give a history 
of a cold or sore throat. Bacteria L r et- into the 
middle ear by way of the eustachian tube. 

Symptoms. — Severe earache which is not ag- 
gravated by pressing 1 on the tragus or manipulat- 
ing the auricle. Fever may be present. Upon 
looking at the ear drum with an otoscope, one will 
see that it is red and bulging. (Normally it i- a 
silvery white color). No drainage is present un- 
less the drum has ruptured; then pus will appear 
and the patient will have relief from pain. 

Treatment. — 1. Nose drops of neosynephrine 
one-fourth percent four times a day. Have the 
patient assume the usual position for giving ni 
drops: then turn his head to the affected side. 

2. Warm -aline gargle four time- a day. 

3. Warm glycerin may be dropped into thl 

to help relieve the pain. This tnu-t be done only 
if the ear drum is intact. 

1. Penicillin (crystalline G) 50,000 units ever] 

:> hour-. 
... Aspirin, L0 grains, and codeine. '.. grain, for 

pain. 



120 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



6. When drainage is present, the ear canal must 
be kept clean and dry by using cotton wicks. 

7. Never irrigate an ear in the presence of otitis 
media. 

8. Force fluids. 

9. A person who has had an otitis media and 
begins complaining of tenderness and pain behind 
the ear should be regarded as a mastoiditis patient 
and be hospitalized. 

Ruptured Ear Drum (Without Infection) 

Cause. — Normally results from blow to the 
head, diving, or blast of air, as from an explosion. 

Symptoms. — Sudden, sharp pain in the ear. 
Bleeding from the ear. Upon observing the ear 
drum with an otoscope, one may see frank blood 
or a black area (the rupture) in a white, shiny 
drum. 

Treatment. — 1. Nothing need be done in the 
way of treatment except to be aware of infection 
developing. Then institute otitis media treatment. 

2. Warn the patient against swimming. In- 
struct patient to put cotton in the ear while tak- 
ing a shower. 

3. Aspirin, 10 grains, and codeine, y 2 g 1 *^ 11 ? 
for severe pain. 

Sinusitis, Acute 

Cause. — Inflammation of one or more of the 
sinuses, usually accompanying or following a head 
cold. 

Symptoms. — Get history of any previous at- 
tacks. The patient generally complains of head- 
aches in the frontal or maxillary areas. He may 
or may not have fever. If drainage is adequate, 
pus will run from the nose. There may be ac- 
companying inflammation of the ears and throat. 

Treatment. — 1. If fever is present the patient 
should be put to bed. 

2. One-fourth percent neosynephrine, six drops 
in each nostril four times a day. Do not use nose 
drops indiscriminately. If a man is out of doors 
in the cold air, his condition will only be aggra- 
vated by shrinking the tissues. Wait until he is 
indoors to use drops. 

3. Steam inhalations several times a day. If 
it is impossible to set up for steam inhalations, a 
hot shower is helpful. Avoid chilling afterwards. 

4. Heat, such as an infra red light helps re- 
lieve congestion. 



5. Aspirin, 10 grains, and codeine, y 2 grain, may 
be given for severe headaches. 

6. For fever cases penicillin (crystalline G) 
100,000 units intramuscularly every 3 hours. 

THROAT 

Acute Pharyngitis 

Acute inflammation of the mucosa of the throat. 

Cause. — Most often brought about by organ- 
isms that cause the common cold. 

Symptoms. — Soreness and inflammation of the 
throat. The appearance of the throat will depend 
upon the causative agent. In acute follicular 
tonsillitis the gross picture will be that of white 
or yellowish spots of pus in the crypts of the ton- 
sils. These are generally easily brushed off. A 
typical streptococcal throat is very red and swol- 
len. A grayish membrane may be present over 
the tonsils. Systemic reactions: Chilliness, 
malaise, headache. Fever and increased pulse 
rate. Great difficulty in swallowing. Glandular 
swelling. 

Treatment.— 1. Isolate and put to bed. (See 
"Isolation technique"). 

2. Hot saline gargles every two hours. 

3. Penicillin (crystalline G) 100,000 units in- 
tramuscularly every 3 hours. 

4. Aspirin, 10 grains, as needed for relief of 
pain. 

5. The diet may be a problem due to the pa- 
tient's difficulty in swallowing. Bland foods are 
preferred usually. Fluids should be given freely. 
(Refer to the chapter on diets.) 

6. Hospitalization should take place at the 
earliest time possible. 

Laryngitis 

Cause. — An inflammation of the mucous mem- 
brane of the larynx usually brought about by the 
organisms that cause the common cold. In re- 
current cases of laryngitis without accompanying 
symptoms of a cold, such chronic conditions as 
polyps, cancer, or tuberculosis should be borne in 
mind. A consultation should be granted. 

Symptoms. — Irritation of the throat and 
hoarseness. Sometimes fever. 

Treatment. — 1. Absolute bed rest. 

2. No smoking. 

3. Steam inhalations. 



FIRST AID AND EMERGENCY PROCEDURES 



121 



l. For acute conditions with fever, penicillin 
(crystalline G) 50,< units intramuscularly everj 

.'5 hours. 



PSYCHIATRIC DISORDERS 

The Immature Personality 

()m> who in the face of Dew adjustments finds 
himself incapable of taking responsibilities. A- 
a result, he may react in ■ childish manner. 

(Often found in the younger aire group). 

Characteristics, i Rarely do all of these exist 
in one person). History <>t' overprotection at 
home; sometimes a broken home situation. Ego 
centric — finds it difficult to get along with his 
buddies. Under emotional strain he may :_ r <> 
A.WOL, perhaps become hostile, have temper 
tantrums, or become tearful. He may have com- 
plaints that are organically unfounded, such as 
headache, sticking pains in his chest, <>r gastro- 
intestinal symptoms. Bedwetting. Sleep walk- 
ing or talking. Sometimes uses suicidal gestures 
as an attention-getting mechanism. 

Treatment. — 1. A sincere attempt should be 
made to find out the difficulty hack of this be- 
havior by skillfully getting the patient to talk 
to you. 

_'. Your judgment, understanding, and counsel- 
in*: come into play in helping the patient. 

3. If the above fails, a neuropsychiatric consul- 
tation may be advisable. 

The Psychoneuroses 

A group of mental disorders that are mild in 
character. They are actually substitution reac- 
tions that come into play, rather than ones that 
would he considered normal. Some of the reac- 
tions under this heading are: 

Anxiety hysteria. — Sieves of anxiety, appre- 
hension (sometimes accompanied by palpitation), 
excessive perspiration, vomiting, and diarrhea. 

Conversion hysteria. — Manifested by such 
phenomena as sudden blindness, paralysis of one 
or more of the extremities, and anesthesia of a por- 
tion of the hody. This again servo as a substitu- 
tion to prevent gratification of certain unconscious 
desires. 

Compulsion neuroses. — A situation in which a 
person feels compelled to carry out acts which he 



realizes are uniiecce.-.-an orsometiini . i i | 

t ional. 

Treatment. — I. Neuropsychiatric consul! i 
arc in oiilcr if these conditions continue to intei 
fciv u ith the per-oii'- efficiency . 

2, Vvoid being critical. An understanding at 
tit ud" i- io he maintained at all t imes. 

The Acute Psychoses 

S\ mptoms. — i The follow ing symptoms are gen- 
eral classifications of the various psychoses and are 

rarely all seen in one per-on. ) Withdrawal from 

the group; uncommunicative. Delusions and hal- 
lucinations; com act with the environment is pom. 
Overactive, flighty, distractible, overtalkative. 
Deep depression, possible suicidal attempts, death 
wish. Idea- of persecution. Combative. 

Treatment. — 1. 1'ut the patient where he can- 
not harm himself. 

2. Do not use restraints unle— absolutely neces- 
sary. 

3. Get everything out of the room, including 
the bunk, if possihle. 1'ut the mat tie-.- on the 
deck. 

4. If the patient is combative and a separate 
room is not available, put the patient to bed and 
use restraints. This i- best accomplished by using 
folded sheets at the ankle-, above the knee.-, and 
under the armpits. Wristlets must also he em- 
ployed. If they are not available, ase folded 
towels. Avoid restraint overthe chest and abdo- 
men. 

."». Make sine that all material- with which the 
patient might harm himself are removed. Glass 
of any type, Lost rumentS, and belts are all potential 
means of committing suicide. 

6. If feeding becomes a problem, the patient 
may need to he gavaged. t See chapter on nursing 
for proper technique). 

7. The patient may need ;i sedative if violent. 
Paraldehyde is the drug of choice: average dose 
4 to Hi cc by mouth, rectally, or intramuscularly 

( dee] i ) . 

Points to remember regarding the neuro- 
psychiatric patient. — 1. Attempt to understand 
yourself and your own personality so that you will 
not he prejudiced in the light of yourself. 

•_'. Do not make a neuropsychiatric diagi 
Always -end the patient in for consultation or io 
the hospital with diagnosis undetermined. 



11 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



3. Enter facts as you see them ; make objective 
reports on the health record. Keep adequate and 
complete records. Subjective complaints should 
also be entered in quotations using patient's own 
words. 

4. Keep all neuropsychiatric records and infor- 
mation confidential. 

5. Never be dictatorial; aggression always pro- 
duces counter aggression. 

6. Vagueness and "beating around the bush" 
are commonly seen in persons who are attempting 
to bare their feelings. This vagueness stems from 
a feeling of pride and also a feeling of shame on 
the part of the patient. For this reason force or 
aggression of any type are worthless. 

7. Develop a willingness to give these patients 
as much understanding as possible. 

8. Treat all patients alike ; show no favoritism. 

9. In minor disorders, rather than hospitalizing 
a patient, request a neuropsychiatric consultation 
if you cannot assist the patient in any way. 

10. Watch those who are overly elated or overly 
depressed much of the time. Sometimes a serious 
psychosis can be thwarted if observed early. 

11. Never give opiates unless there is a medical 
or surgical reason. Paraldehyde is the drug of 
choice. 

12. Remain calm if patient vilifies you or calls 
you names. 

OBSTETRICS 

Labor. — A long series of rhythmical contrac- 
tions of the uterine wall that dilate and efface the 
cervix and then expel the uterine contents. 

Estimated date of labor. — The estimated date 
of beginning of labor can be determined by count- 
ing back 3 months from the first day of the last 
menstrual period and adding 7 days. For exam- 
ple: If the first day of the last menstrual period 
was 16 May, the estimated date of beginning of 
labor is 23 February of the following year. 

Stages of Labor 

First stage. — From the time of the first con- 
traction until the cervix is completely dilated and 
effaced. 

Pains are irregular at first and then they be- 
come regular with shorter intervals between ; they 
increase in quality. 



A woman having her first child generally is in 
labor longer (about 16 to 18 hours) than one who 
has delivered previously. 

Second stage. — From complete dilatation and 
effacement of the cervix through birth of the baby. 

Contractions increase in rhythm and quality; 
they usually occur every 2 to 3 minutes and last 
60 to 70 seconds. 

The patient is restless and complains of pain 
that radiates down the thighs. 

The patient bears down involuntarily. 

A bloody, mucus discharge is released. 

Membranes rupture and about 700 to 1,000 cc. 
of fluid escapes. 

As the head descends, bulging of the perineum 
will occur with each contraction. 

This stage is about 2 hours long if a woman is 
having her first child. For those who have had 
more children, it may be comparatively short. 

Third stage. — From delivery of the infant 
through delivery of the placenta (afterbirth). 
This lasts about 15 to 30 minutes. 

Care of the Mother 

1. Signs of approaching delivery are those listed 
under the second stage of labor. Here their inten- 
sity is generally greatly increased. 

2. Light food should be given early in labor 
but should be withheld during the second stage. 
Give fluids by mouth. 

3. Early in labor, it is advisable to see that the 
mother receives a cleansing enema and a shower 
bath. 

4. The perineum and anal area should be 
cleansed with a heavy soap solution. The peri- 
neum may be shaved. At all times, no fluid should 
be allowed to enter the vaginal canal. The patient 
should put on a clean gown. 

5. The patient should be urged to void frequent- 
ly. A full bladder retards labor. 

6. Early in labor she may be up and about. 
After the membranes rupture or contractions be- 
come hard (about every 5 minutes), she should be 
put to bed. Then if she wishes, allow her to pull 
on something, such as a sheet tied to the foot of 
the bed on either side. 

Equipment Needed 

1. Freshly laundered (preferably autoclaved) 
towels. Select old towels and if autoclaving is 



FIRST AID AND EMERGENCY PROCEDURES 



123 



impossible, bake them in a hot oven until they 
turn brown or scorch them with an iron. 
2. Two sterile large bemostats or KelU clamps. 

.'!. One sterile BcisSOrS. 

I. A Bterile basin or buckel to receive the after 
birth. 

.'). A sanitary bell for the mother or mi impro 
vised belt made of gauze bandage. 

d. Kotex or improvised pads made of cotton and 
gauze. These should preferably be sterile. 

7. Several targe containers of boiled water. 

8. Umbilical tape or four strips of sterile 1 inch 
gauze bandage about 10 inches loner. 

'.». Clean blanket for the baby. 
10. Sterile dressing i I by I inches are best) and 
3-inch roller bandage lor dressing the cord. 

II. One percent silver nitrate for the baby's 
eyes. 

Procedure for Delivery 

No two women go through Labor and delivery in 
exactly the same manner. The information given 
here is of a general nature. 

1. When touching the mother, make certain that 
your hands are Scrupulously clean at all time-. 
(Sterile gloves are advisable during actual de- 
livery). 

2. Never perform a rectal or vagina] examina- 
tion. 

3. The mother should assume the dorsal reeum- 
bent position during delivery. 

4. Have a good light at hand if possible. 

5. The head is usually horn first. Place the left 
hand under the baby's lace and he prepared to 
receive the body with the other hand. 

6. It is advisable to wipe the baby's face as soon 
as it is exposed. 

7. Check with your forefinger to make sure that 

the cord is not wrapped around the neck. It 

; ry to slip it over the baby's head to prevent stran- 
gulation. If this cannot he done, clamp the cord 
with two hemostats placed -J inches apart, ami 
cut the cord between them. If clamps are not 

available, use the umbilical tape or gauze, tie -i 

inches apart with a linn tight square knot, and cut 

between them. 

8. After birth, place the baby in the blanket, 

being sure not to place or put tension on the cord. 



Make sure the hah\ breathe- norin:ill\ and t 1 
the throat and no-.- an free of mucus. Si ipp 
the sole- of the habC- feet with the folilin-. 

often brings out '1"' Welcome cry. Holding the 
baby up bj its feet help- mucus t<> (low out. i B 

sure to put one finger between the ankle- and lmld 

t he infant ovei t he bed. i Do not spank or sw 
the baby. 

'.». (lamp the cord with the -terile heme 
or tie with -terile tape or gaUZC bandage as di- 
rected iii No. 7. Cut with sterile scissors between 

t he clamp- or t ies. 

10. Wrap the baby in warm blankets; place it 

on its side and proceed with care of the mother. 

11. Receive the afterbirth in a -terile ha-in. 

1l'. Cleanse the perineum by mean- of pouring 

-terile water over it ; apply the sanitary belt and 
kotex (cotton and gauze pad I. 

13. Keep close watch on the uterus. It must 
remain firm or bleeding will he profuse. It should 

he about the size and consistency of a •_'! apefruit 
and be felt just below the umbilicus. If it softens, 
massage by rubbing the abdomen just below the 
umbilicus. 

14. The mother'.- blood pressure should he taken 

at 30-minute intervals i if possible) for three times 

a Iter delivery. 

i:>. Check on the uterii- frequently. 

16. After delivery the mother will probably 

want to sleep. A mild hypnotic may be given hut 
usually is not necessary. 

Important Points To Remember 

1. If delivery is rapid or occurs under circum- 
stances that are not ideal, do not attempt to pi 
vent the birth. In-truct the patient to l.reathe 
deeply through her mouth and if at all po— ihl. 
keep from bearing down. This may keep her from 
delivering for a Bhort while. 

•j. In an absolute emergency, one needs the taps 
for tying the cord, a -terile scissors, ami a basin 

to receive the placenta. 

3. Never examine the patient internally. 

1. Never ptlll the cold. 

;.. Watch the newborn for cyanosis and bleeding 

of the cord -tump. The former can often he 
lieved by clearing any mUCUS from the nOSC and 
throat and by cau-ing the baby to cry: the latter 
can he relieved by retying the cold. 



i: 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



ABORTIONS 

Definition — Spontaneous, therapeutic, or crim- 
inal interruption of pregnancy before the fetus 
is viable, generally occurs during the first 2 
months. 

Symptoms. — Vaginal bleeding, often blood 
clots. Cramping pains in pelvic region. Back- 
ache. 

Treatment. — 1. Put to bed in shock position if 
necessary. 

2. Morphine sulfate, % grain, or paregoric, 
4 cc. by mouth. 

3. Save all blood clots or membranous material 
expelled for examination by a doctor. 

4. Get the patient to a doctor as quickly as 
possible. 

ANESTHESIA 

Anesthesia as it is known today requires dili- 
gent and extensive training and study. Only in 
times of emergency, when a qualified anesthetist 
is not available, should a hospital corpsman ever 
attempt to administer an anesthetic. The types 
of anesthesia considered the safest and the cir- 
cumstances under which they should be given are 
included in the following pages. Remember al- 
ways that when a person is being subjected to 
anesthesia, his higher centers -become paralyzed 
and circulation, as well as respiration, is some- 
what depressed. For this reason, great care must 
be taken to have on hand materials and equip- 
ment that can combat any untoward reaction. 

Local Anesthesia 

Definition. — Desensitizing of a part of the body 
without interfering with consciousness. 

Types 

Nerve block. — The injection of the anesthetic 
agent is made some distance from the region to be 
anesthetized by blocking off the sensory nerves. 

Infiltration anesthesia. — The blocking of nerve 
endings in the region itself. Limited to area 
where drug is injected. 

Topical anesthesia. — The application of anes- 
thetic agent to skin or mucous membrane; e. g., 
cocaine is effective if applied to the mucous mem- 
brane but not when applied to the skin. Ethyl 
chloride will produce anesthetic effect due to re- 
frigeration. 



Anesthetic Agents 
Procaine (novocaine) : 

Least toxic of all local anesthetic agents. 

Most commonly used in one-half or 1 percent, 
sometimes 2 percent solutions. 

Can readily be sterilized by heat. 

May be prepared either with isotonic saline 
or distilled water. 

Total dose of procaine tolerated is about 1 
gram. 
Cocaine (very toxic) : 

Is used only for topical application to mucous 
membranes in 4 or 5 percent solutions. 

Creates tremendous shrinking of tissue as 
well as producing vasoconstriction within the 
area. 

Great tendency to produce respiratory and 
cardiac depression. 

Solution must be freshly prepared. 

Heat deteriorates cocaine rapidly. 
Other agents (very toxic and to be avoided) : 

Nupercaine. 

Pontocaine. 

Metycaine — can be used safely with care. 
General precautions. — Remember when doing 
a local infiltration these toxic manifestations must 
be kept in mind at all times : 

1. Central nervous system stimulation charac- 
terized by pallor, perspiration, tremors; and if 
severe, even convulsions which may be followed 
by death. Emotional reactions and stimulation 
which are due to epinephrine given may resemble 
early central nervous system toxic reactions. This 
is brought about as a direct function of the dose. 
Keep doses at a minimum. 

2. Anaphylactoid reaction is extremely serious 
in that it is generally manifested by sudden death 
after the anesthetic agent is given. The amount 
of anesthetic agent used is immaterial in relation 
to this type of reaction. It is due to reaction of the 
body to the drug in an unknown way ; fortunately, 
it is rare. 

To prevent toxic manifestations, give the 
patient iy 2 to 3 grains (100 to 200 mg.) of nem- 
butal or Seconal before injecting procaine. Ideal- 
ly, the patient should receive the barbiturate about 
1 to iy 2 hours beforehand. If sodium amytal or 
sodium pentothal is available, it should be close 
at hand for emergency intravenous use. 



FIRST AID AND EMERGENCY PROCEDURES 



125 



Epinephrine is routinely added t<> procaine for 
the purpose of constricting the blood vessels in the 

area and thus prolonging the effect of tin- anes 
thetic agent. Amount used is aboul 5 minims of a 

1 : l(li>U solution to everj ounce of procaine solu- 
t ion. 

Do not use epinephrine when blocking the toes, 
fingers, or ears. It istoo potent a vasoconstrictor 

and will cut oil the blood supply in the digit and 
create irreversible tissue damage. 

Never give a drug unless you have prepared it 
yoursel I'. 

Never give an anesthetic agent unless it lias just 
been freshly prepared. 

Do not inject agent into blood stream. As- 
pirate on the syringe frequently to make certain 
the needle is not in a vessel. 

Remember t hat the route, amount, and rapidity 
with which a drug is given have a bearing on the 
toxic effects of it: i. e., central nervous system 
stimulation. 

Check the patient's blood pressure before and 
alter any procedures involving the use of a local 
anesthet ic. 

Do not use more drug than is absolutely neces- 
sary. 

Equipment. — For doing a local infiltration: 
Sterile: 

Three cc Luer Lok syringe. 
Ten cc. Luer Lok syringe. 
Needles l No. 26'or23 (short) and assorted 
lengths of No. % 2 % 2. depending upon the size of the 
area to be anesthetized. 
Medicine glass or beaker. 

Applicators — as many as needed, and an anti- 
septic 
Drape-. 
(doves. 

Procaine or tiovocaine ampules. 
Distilled water ampules. 

Epinephrine ampule 1: 1000 strength. 
Procedure. — For doing local infiltration: 
1. Assemble equipment. 

2 Shave and scrub the area involved and apply 
antiseptic. 

:'>. Open Sterile materials. Open procaine 
ampule and empty into beaker. Add sullicient 

sterile distilled water tomake the desired strength. 

(1(H) nig. of procaine in in CC. of water makes a 

1 percent solution). Add the epinephrine. ( For 



10 cc of anesthetic drug, I or -i minims oi epine- 
phrine i- sufficient, i 

I. Scrub hand- ami put on sterile glo 

... Fill the .". cc. -\ ringe with procaine and attach 

t he Small needle. 

6. Produce a large wheal (bevel of the needle 

held down) in the skin. This i- the focal point 

from winch you will make your injections. It. 
lor instance, you are preparing the area for -mur- 
ing a large laceration, several wheal- will have 

to be produced. 

7. After producing the wheal, change to a larger 

needle and Byringe a- the situation demand-. 

-v Plunge the needle right through the wheal 

and direct it in line with the laceration. The 
needle should be directed under the -kin BO that 
a blanching of the -kin occur- when the solution 

is injected into the tissues. Express the solution 

ahead of the needle a- you advance it. 

'.». Withdraw the needle -lowly, hut continue to 

express solution as you do so. 

10. As the point of the needle near- the wheal, 

remove the syringe and refill if necessary. Then 

plunge the needle into the -uhcutaneoii- tisSUCS 
and express solution there in the Mime manlier a- 

described above. 

II. When one side of the wound ha- been in- 
filtrated, repeat the procedure on the other -ide. 

12. The infiltration Bhould he made a few centi- 
meter- away from the wound. 

1"». The appearance i in contour) of the .-kin 
should be somewhat like orange peel after you 

have finished. 

14. Action is almost immediate, and i ncisi n^r or 
Suturing can be begun promptly. 

Precaution- 

1. Keep the needle moving .-low ly. the -obit ion 
ahead of the needle. 

2. Pull on the plunger frequently, especially in 

the Vascular area- to make -lire you have not 

punctured a blood vessel. Hematomas may result 
as well a- an enhancement of toxic effects. 

:'>. Remember to puncture the -kin as little as 
possible. That i- the rea-on for producing the 
wheal- l focal point- i. 

I. Under no circumstances Bhould the injec- 
tion- be made from within the laceration out into 
the tissues, nor should the injection- ever be di- 
rected toward the laceration, as anesthesia i> not 



126 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



very effectual; it requires more puncturing, and 
also infection from the wound can easily be taken 
into the tissues. 

5. A sedative, such as nembutal or Seconal, is 
always in order to allay toxic effects of the anes- 
thetic and to calm a patient who undoubtedly is 
experiencing apprehension. 

Spinal Anesthesia 

Definition. — Administration of anesthesia into 
the subarachnoid space of the spinal canal. 

Site of injection. — Between the third and 
fourth or fourth and fifth lumbar vertebrae. 

Position of the patient. 

Lateral. — Knees sharply flexed, head brought 
forward. 

Sitting. — Patient's feet rest on stool, hands 
folded in lap, head leaning forward on shoulder of 
assistant. 

Drugs Most Commonly Used 

Pontocaine.— Usually about 8 to 10 mg., de- 
pending upon the type of surgery to be done. Due 
to the fact that it is slightly lighter than the spinal 
fluid, it is often weighted with equal parts of 10 
percent dextrose. Its action is prolonged-^-usually 
lasts 90 to 120 minutes. 

Procaine (novocaine). — Dose 1 mg. per pound 
of body weight or 50 to 100 mg. total. Is lighter 
than spinal fluid. Generally mixed with spinal 
fluid for injection. 

Equipment. — Sterile : 

One 2-cc. syringe. 

One 5- or 10-cc. syringe. 

Five needles : Hypo, No. 21 and 23 ; spinal No. 
18, 19, 20. 

Four applicators. 

Three flats. 

One sacral towel. 

One medicine glass. 

One towel. 

Gloves. 

Antiseptic. 

Drug to be used. 

Procedure. — Your duties are those of assistant 
to the medical officer : 

1. Assemble all equipment. 

2. Put the patient in the position the doctor 
desires. 

3. Prepare the area with antiseptic. 



4. Have tray open and gloves at hand for the 
medical officer. 

5. Hold the patient in position while anesthetic 
is being given. 

6. After administration is finished, put the pa- 
tient in the proper position. For solutions lighter 
than spinal fluid, lower the head. For solutions 
heavier than spinal fluid, raise the head. (The 
medical officer will instruct you as to the correct 
position.) 

Precautions. — Keep in mind when helping with 
a spinal anesthetic : 

1. A spinal anesthetic blocks the sensory, motor, 
and sympathetic nerves (the sympathetic nerves 
keep the blood vessels constricted normally) ; 
therefore when the block occurs, the blood pres- 
sing drops due to dilatation of the blood vessels. 
To prevent this, give ephedrine just before the 
anesthetic is started; 5 to 10 mg. is an adequate 
dose if given intravenously ; 25 to 50 mg., if given 
intramuscularly or subcutaneously. 

2. Prepare the patient mentally. Watch your 
conversation and remarks. Remember he is awake. 
Reassure him. 

3. It requires about 3 to 4 minutes for procaine 
to become fixed and about 6 to 7 minutes for pon- 
tocaine. Changes of position of an anesthetized 
patient are dangerous immediately after the spinal 
is given. However, modification of the operating 
table is relatively safe, and any change made 
should not effect the level of anesthesia once it 
has become fixed. 

4. During the operation: 

Keep check on blood pressure and pulse every 
60 seconds if possible during the first 5 min- 
utes, then every 5 minutes. 

Have a circulatory stimulant, such as ephed- 
rine or epinephrine, at hand. 

If the anesthesia should bring about respira- 
tory adversities, the medical officer may require 
artificial respiration as well as oxygen to be 
given. 

5. Toxic effects of the anesthetic drug are the 
same in spinal anesthesia as in local. Should the 
patient be sensitive to the drug, he may have : 

Nausea, vomiting. 

Excitement. 

Rapid pulse. 

Pallor, syncope, breathing stops. 

Convulsions (if severe). 



FIRST AID AND EMERGENCY PROCEDURES 



127 



Sodium Pentotha] or Sodium \mvlal should be 

at hand with syringe and needle for intravenous 
administral ion. 

GENERAL ANESTHESIA 

Definition. ( lomplete loss of consciousness and 
sensation. 

Stages of Anesthesia (4): 
Stage 1. — Analgesia: 

Patieni begins to lose consciousness. 

Reactions to pain and stimuli lessened... 

Hearing becomes more sensitive; therefore 
surrounding areas should be kept quiet. 

Sometimes used for minor denial work. 
Stage 2. — Delirium or excitement state : 

Often violent movement of arms: patient 
st niggles. 

May talk or cry. 

Pulse rapid, skiu flushed. 

Lasts only a few minutes. 
Stage 3. — Complete or "Surgical" anesthesia: 

Patient is calm and quiet . 

Muscles are relaxed. 

Reflexes disappear. 

Breathing deep and regular. 

Four Planes of Stage 3 Anesthesia 

Plane 1 — Light. — Complete loss of all sensa- 
tion. Pulse, respirations, and blood pressure are 
normal. Adequate for surgical work that does not 
involve the periosteum or peritoneum. 

Plane 2 — Deepening respiration. — Inspiration 
and expiration of the same length. Muscular re- 
laxation sufficient for such operations as hernia, 
fracture.-, tonsils. Some respiratory paralysis is 
evident. 

Plane 3 — Deep anesthesia. — Intercostal mus- 

cles no longer assist with respirations; all dia- 
phragmatic breathing. Inspirations somewhat 
delayed. Used only at the beginning of surgery 
when deep work is to he done and complete re- 
taxation of the patieni must be assured. Bespi 

ratory paralysis, however, has become marked and 
it is unsafe to keep a patieni at this level of anes- 
thesia for any length of time. 

Plane 4 — Paralysis of diaphragm. — Can be 
noted by sinking of the abdomen when the patieni 



takes a breath. Breathing become* rerj hallow. 

Cardiovascular system is seriously im d. 

Stage 4 — Toxic Btage. Respiration 

heart fails, deal li. 

Hememher. — When administering general 
thesia : 

1. The cardiovascular and respirator} systems 
arc closely linked. Both must be kept Function- 
ing properly. If one IS affected, the other 01 . 
affected. 

2. The blood must throw otr carbon dioxide, 
which is considered a waste product If it be 

comes stored up in the hod v. it will cau-e increased 

respiratory rate. 

3. In cardiac 1'ailmv. systolic and diastolic pres- 
sures i_ r o down and the pul-e rate gOM up. 

4. Keep airway open from the nose to the al- 
veoli. Never leave an anesthetized patient 
alone. 

."). Under deep anesthesia, the reflexes in the 
pharynx and larynx become paralyzed. This can 
cause secretions to How into the trachea and bring 

aboul respiratory obstruction. 

6. Before beginning any type of general anes- 
thesia, you should have certain equipment at hand 
and in good working order : 

Oxygen and a means for giving artificial res- 
piration, such a> a re breathing hag attached 
to the oxygen. 

Intravenous Quids and equipment for giving 
Bame. 

A vasoconstrictor such as ephedrine. 

Sterile bj ringes and needles. 

A ii'ways. 

Suction apparatus-— a 30 to 60 <■<•. Byringe and 
a \o. it; catheter do well if no other equipment 
is available, 

Tiltahle table so that the patient"- head can 
be lowered if nc c--:ii v. 

Blood pressure apparatus. 

Additional people to assist 

Types of General Anesthesia 
Inhalation 

Ether. — Offers a fairly wide margin «>f safety 
and is the only inhalation anesthetic agent that 
should be given under supervision by an untrained 
person. It will deteriorate rapidly upon exposure 

to light, heat, or air. Kther to he used for a gen- 



1.3 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



era] anesthetic should be from newly opened con- 
tainers. 

Equipment 

Ether can. — Before opening use older ether to 
clean all lacquer from the top of can. Cut out 
metal cap, replace with stopper from which a 
wedge has been cut on each side. In one side in- 
sert piece of gauze bandage as a wick to aid in 
control of ether from can. Or, without removing 
metal cap, insert safety pin through cap and pin 
a small piece of bandage to the pin. Try both 
methods to see which works best for the indi- 
vidual concerned. 

Mask frame. — Cover with about 12 to 16 layers 
of gauze. (Just before using mask try a number 
of drops of ether to be certain that the ether will 
not leak through). 

Mechanical airways. — Some type of protection 
for patient's eyes, preferably absorbent cotton; 
gauze or rubber tissue will do. 
Suction apparatus. 

Positive pressure oxygen equipment, if avail- 
able. 

Tongue blades. 

Extra towels and emesis basin. 
Extra cover for the mask. 
Blood pressure apparatus. 
Stethoscope. 
Clock. 

Be certain that all electrical equipment which 
may have to be used during the course of the 
anesthetic is plugged in. Be certain that the 
emergency light is working, and that the switch 
will not emit a spark if it has to be turned on. 

Be certain that the assistant for the anesthe- 
tist knows that no smoking is permitted in the 
area, and that he has, if at all possible, a C0 2 
fire extinguisher and knows how to operate it. 
Ether is very highly flammable, ether 
fumes explosive. This must be remembered. 
Precautions and procedures. — No fluids or 
food for 8 to 12 hours preceding anesthesia. 

Remove loose dentures. Be certain that the pa- 
tient has no other loose objects in the mouth, such 
as chewing gum. 

Preoperative medications should include atro- 
pine. (The medical officer will prescribe). 



Restrain patient well; arms with draw sheet, 
wide strap above knees. Be certain that the pa- 
tient is in as natural a position as possible. The 
restraining apparatus should not be so tight as to 
interfere with circulation. 

Never attempt to anesthetize a patient alone. 

Have an assistant standing by during the in- 
duction period. 

Reassure the patient. Talk to him a minute or 
two before placing the mask over the face. The 
odor of ether is obnoxious to many people. If 
available place one or two drops of an essential 
oil ; such as, oil of orange, spearmint, peppermint, 
or anise on the mask before beginning the anes- 
thetic. 

Avoid bright lights, especially overhead, if pos- 
sible. Avoid any type of noise, talking, laughing, 
or similar noises. 

Allow the patient's head to assume a natural po- 
sition on the table without a pillow. 

Start induction slowly, fast administration at 
the beginning may bring about a laryngospasm. 
Hold the little finger of the left hand slightly 
under the edge of the mask near the chin to per- 
mit a little air. After a few drops of ether have 
been placed on the mask and the patient has 
taken a breath or two remove the mask and let 
him take a few more breaths. Replace the mask 
and continue. Let him breathe again after a few 
breaths if there are signs of real fighting. As tol- 
erance for the vapor increases, increase the speed 
of administration. 

All patients respond differently to ether, and 
no set rule can be established as to rate of ad- 
ministration. Keep talking to the patient in a 
low voice, in other words "talk your patient to 
sleep." 

Vomiting, retching, and aspiration are very apt 
to take place during the period of induction. If 
the patient vomits, be certain that the air pas- 
sages are well cleared before proceeding. 

In hot, moist climates ether does not vaporize 
well, condensation occurs. A towel wrapped 
around the face and adjoining the mask may aid 
in vaporization. 

Keep the mask damp, not wet, change cover if 
necessary. 

The medical officer will inform you when mus- 
cular relaxation is sufficiently good. The level 
of anesthesia should then be maintained. 



FIRST AID AND EMERGENCY PROCEDURES 



129 



If the patient lias obstructed breathing, clear 
the air passages. Pull the tongue forward and 
bring the jaw forward by exerting pressure be- 
hind the angle <d' the jaw. An airway may be 
inserted if necessary. 

Danger signs during anesthetic. -The pulse first 
increases then decreases; weak shallow respira- 
tions; ear lobes and base of anger nails begin to 
turn blue (cyanotic) : pupils fail to react to light ; 
blood pressure begins to fall. 

If the patient begins to develop these signs re- 
move the mask for 2 or 3 minute-. Be prepared 
to administer oxygen and either respiratory or 
circulatory stimulant.-, whichever are necessary. 
The surgeon will direct this. 

Keep the surgeon informed as to developments. 
If it appear- that the patient is receiving too much 
et her, inform him. 

At times muscular rigidity may develop during 
abdominal operations. This may be an indication 
of too much ether. Remove the mask completely 
and permit to breathe normally for _ or 3 minutes. 
This may reduce the rigidity. Resume anesthesia 
when rigidity is relaxed. 

Discontinue ether gradually, as surgery conies 
to a close. Keep in mind that vomiting and pos- 
sibility of aspiration are apt to oceur during this 
period. 

The patient should be awake when lie returns to 
bed. Reflexes should be functioning. 

Precautions that should be observed: 

Do not permit woolen blankets to come in con- 
tact with the hare skin of patient. Use sheet for 
protection. 

dust before beginning anesthetic have the deck 
of the room run over with a wet swab, do not dry. 
This will aid in grounding any static electricity 
that persons may create. 

Have all persons who may enter the room touch 
metal just before entering. This may ground any 
static electricity. 



Do not permit cautery to be u-ed in room w here 

anest hesia i- being given. 

Remember that ether fume- are heavier than 

air and will tend to -ink toward the floor. 

Other general inhalation ane-thctic-. <\ 
to be administered by an untrained person). 

Chloroform. — Although not flammable oi 
plosive, in the presence of an open flame, a highly 
toxic gas is generated (phosgene). 

Vinothene. Ethylene. 

Cyclopropane. Ethyl chloride. 

Nitron- oxide. 

Intravenous Anesthesia 

Sodium I'entothul. — A barbiturate generally 

used in '2 ] ) percent solution. 

Precautions. — Should be injected slowly, rate 
ah. mt l vr. ea.h 30 seconds. When starting in- 
jections it is best t" count, 1 and 2 and :'. and 1 up 
to 30, thus making certain that injection i- not 
too rapid. It i- easy to overdepresa the patient 
with rapid injection. 

Once Pentothal has been administered it can- 
not be removed from the hi 1 -t ream. 

It is a profound depressant to the respiratory 
and to a certain extent to the cardiovascular 
systems. 

The possibility of laryngospasm is great 

Pentothal should primarily be u-ed a> an in- 
duction agent and as a supplement toother good 
ane-thet ic agents. 

Pentothal used as an anesthetic does not give 
good muscular relaxation. This should be re- 
membered, especially if to be u-ed a- the anesthetic 

in an abdominal operation. 

Rectal Anesthesia 

Avertin. A dangerous central nervous system 
depressant that i> used only in ?ery carefull] 
lected cases. Requires expert training to admin- 
ister properly. 



EMERGENCY DENTAL TREATMENT 



Dental first aid is the temporary and emergency 
treatment for the relief of pain and discomfort 
given to persons suffering from disease or injury 
to dental structures until regular dental care can 



he given. 



The treatment a- outlined here IS intended only 

for the relief of pain associated with, or occurring 
as a sequel to. trauma, infection, and postopei 
complications. All cases receiving emergency 

dental treatment should he referred to a dental 



130 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



officer as soon as possible for further treatment. 
The effectiveness of dental first aid depends upon 
an accurate diagnosis and the correct application 
of the remedies indicated. In order to render 
such treatment properly, one must have a general 
knowledge of the structures involved. 

An oral examination reveals, in addition to the 
natural teeth present, the maxillae, mandible, and 
the tongue, all of which (except the teeth) are 
covered with mucous membrane. The roots of 
all teeth present are imbedded in the alveolar 
processes of the maxillae or mandible. In the 
area adjacent to the alveolar processes and sur- 
rounding the necks of the teeth is a fibrous tissue 
called the gingiva (gum). 

The bulk of each tooth is composed of a bone- 
like structure called dentin, which is covered by 
enamel to form the crown and by cementum to 
form the root. The root of each tooth is attached 
to the alveolar bone by a fibrous tissue called the 
periodontal membrane. Within the crown and 
root of a tooth is a filament of soft tissue called the 
pulp. The nerves and blood vessels enter and 
leave the pulp through openings at or near each 
root end or apex (fig. 116) . 



Enamel 
Dentin 

Pulp 




I **%;■ Gingiva 

t ■'■ '•'•'\ Alveolar 

,' ~ Bone 



Periodontal 
Membrane 

Cementum 



Figure 116. — Sketch of Molar Tooth and its Supporting Structure. 

There are 32 teeth in the normal, permanent 
dentition ; there are 16 in each jaw or arch. Each 
normal arch of 16 teeth possesses 4 incisors, 2 cus- 
pids, 4 bicuspids, and 6 molars. In the Armed 
Forces System of Classification these teeth are 
numbered from 1-32, beginning with the upper 
right third molar or wisdom tooth and continuing 
to the upper left third molar which is No. 16. The 



lower left third molar is number 17 and, continu- 
ing around the lower arch, the numbering ends on 
the lower right third molar which is No. 32 (fig. 
117). The understanding of this nomenclature 
will enable the hospital corpsman to accurately 
record any emergency treatment in the patient's 
Dental Record (NavMed H-4). The Manual of 
the Medical Department should be consulted for 



RECORD OF DENTAL EXAMINATION 




I I I ££i 

.^ <J ft 






Jo 



Is 






Figure 1 1 7. — The Dental Record Chart of the Form H— 4. 
nomenclature has been added. 



Tooth 



detailed information pertaining to method and 
procedure for making such entries as well as in- 
structions pertinent to obtaining dental services 
from naval or civilian sources. 

Since pain or discomfort may be indicative of 
a serious pathologic condition, all cases which re- 
ceive emergency treatment must be referred to a 
dental officer as soon as possible for professional 
and definitive treatment. The hospital corpsman 
on independent duty should make every attempt 
to prevent conditions which might result in dental 
emergencies. By using intelligent forethought, 
the corpsman can arrange for periodic examina- 
tions and treatment of the men attached to his ship 
or station at such times as the services of a dental 



FIRST AID AND EMERGENCY PROCEDURES 



131 



officer arc available t<> them. Health records 
should be examined to determine if they contain 
up-to-date dental records. It' they are missing or 
not up-to-date, he should assure himself thai they 

arc supplied or corrected since they may furnish 

the only. means of positive identification if such a 
need arises. In addition, a current dental record 
will he of valuable assistance should dental first 
aid measures become necessary. 

The personnel of craft, not having a dental of- 
ficer attached, should he examined by the hospital 
corpsman prior to arriving in port for the purpose 
of classifying the crew into the following 
categories: 

1. Those requiring or having received emer- 
gency treatment. 

•1. Urgent dental attention indicated hut not of 
an emergency nature. 

-'5. Routine treatment indicated. 

4. No dental complaint hut the individual re- 
quests a dental appointment for the purpose of a 
check-up. 

5. Xo dental complaint and the necessity for a 
dental appointment is not indicated nor requested. 

The list of personnel requiring or requesting 
dental treatment should he delivered without delay 
to the shipyard dental officer or the dental officer 
of a tender, whichever is applicable, for the pur- 
pose of expediting dental treatment in the order 
of established priority. It must he remembered 
that, as a general rule, dental departments of ships 
or shore stations have a large backlog of personnel 
awaiting treatment and it is not always possible 
to provide all of the dental treatment which is re- 
quired in each case. 

In order to determine the first aid procedures to 
follow, one will find in this section a reference 
table which describes some of the more common 
dental complaints and symptoms together with a 
diagnosis and a palliative, temporary treatment. 
Many conditions exist, however, which have not 
been included for reasons that they may tend to 
confuse the diagnosis. In those cases where a 
diagnosis cannot he determined from the signs and 
symptoms outlined in this reference table, certain 
therapeutic principles can he employed on a tem- 
porary basis until professional assistance CAD he 
obtained. These principles will not necessarily 
cure nor harm the patient, hut in most cases they 
will alleviate suffering and minimize complica- 



tions until such time as the patient ■ . \ en 

more effective care. They include tin- appl 
tion of : 

l. Analgesics, hypnotics, or narcotic- for the 
relief of pain. 

\i. Warm or hot saline mouthwashes and 
gargles. 

3 A Mi ipyretics for fever. 

1. Antibiotics or chemotherapy (or both) in full 

therapeut ic dosage. 

.">. Bed resl . 

6. Light and substantia] diet. 

For ready reference the table has been divided 
into the following categories : Stomatitis i inflam- 
matory conditions of the mouth), odontalgia 

I tooth-ichc ), traumatic injuries, serious dental in- 
fections, post surgical emergencies, tumors, and 
other dental conditions. Refer to the proper cate- 
gory and check through the respective complaints 

and symptoms which will lead to an appropriate 
diagnosis and t reatment. 

For the rendering of dental first aid the follow- 
ing armamentaria are BUggested. These can he 
requisitioned as desired to supplement supplies 
and equipment that ma\ he on hand. 

Instruments 
Excavators : 

Instrument, cutting. 
Black, DOS. 68 68 
Handle, niouili mirror 



AcCCMOfiM 

I'll--, dental 

Qause, iodoform % inch 

Tad. cement mixing, paper 

Pellets, cotton 



Mirror, mouth, No. 4 
Pliers. No. 6 i cotton i 
Spatula, cement, No. 324 
Syringe, water. Moffat 



Bolls, cotton 

Blab, mixing (or pad i 



Druga 



Acriila\ Ine hydrochloride, l 
percent aqueous solution 
Analgesics 
Collodion, flexible 
Eugenol 



Hydrogen per 

Protective ointment 

S"dium bicarbonate 

spirit-- of camphor 
/inc . 



DIAGNOSIS AND TREATMENT TABLE 

Stomatitis 

Herpetic stomatitis. 
Alcoholic stomatitis. 
Infection- stomatitis < fig. 118). 
Noninfectious stomatitis i ti^r. 119). 
Aphthous ulcer i fig. ISO). 
Traumatic ulcer, infected (fig, 121). 
Pericoronitis i ti;_ r . 1522 i. 
Pericoronal abscess (figs. 128, 124). 



)32 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Denture stomatitis — nontraumatic (fig. 125). 

Denture stomatitis — traumatic (fig. 126). 

Marginal gingivitis (figs. 127, 128). 

Mild gingivitis (fig. 129). 

Vincent's infection (figs. 130, 131). 

Vincent's angina. 

Dry, burning tongue (fig. 132). 

Herpes labialis (fig. 133). 

Cheilitis. 

Odontalgia: 

Simple toothache (figs. 134, 135, 136, 137, 138, 
139,140). 

Severe toothache, A, B, C (figs. 141, 142, 143, 
144, 145, 146, 147, 148, 149, 150). 

Periodontal abscess (figs. 151, 152). 

Traumatic injuries: 

Jaw fractures (figs. 153, 154, 155, 156) . 
Tooth fractures (figs. 157, 158, 159, 160, 161, 
162,163). 

Chemical burns. 
Thermal burns. 

Serious dental infections: 

Cellulitis (figs. 164, 165). 
Peritonsillar abscess. 
Ludwig's angina. 
Acute osteomyelitis. 
Cavernous sinus thrombosis. 

Post surgical emergencies: 

Hemorrhage. 

Sequestra. 

Dry Socket (figs. 166, 167, 168). 

Tumors 

Other dental conditions: 

Black tongue. 
Geographic tongue. 
Torus palatinus (fig. 169). 
Torus mandibularis (fig. 170). 
Obstructive salivary calculus. 

STOMATITIS 

An inflammatory condition of the oral mucosa 
due to local disorders such as trauma, infection, 
or neoplasm, or to general systemic disorders such 
as avitaminosis, blood dyscrasia, or disease state. 
Stomatitis is evident whenever soft tissues of the 
mouth are painful. Relief of pain is primary 



concern — prevention of further infection and, if 
possible, elimination of basic causes also are im- 
portant. 

Herpetic Stomatitis 

Complaint. — "Sore mouth" "Many ulcers." 
Symptoms. — Entire mucosa inflamed, many 
small greyish ulcers surrrounded by reddish halo. 
Very painful, fever often present, spontaneous 
bleeding from gingivae, duration 10-14 days. 

Treatment. — 1. Antipyretics for fever if pres- 
ent (aspirin, 5 grains, q 4 h) . 

2. Force fluids. 

3. Sodium bicarbonate mouthwashes three times 
daily. (Approximately 2 percent solution — 1 
teaspoon in glass warm water.) 

4. Advise proper oral hygiene and avoid irri- 
tants such as spicy foods. 

5. Relieve and treat upper respiratory infec- 
tion if present. (See The Nose, under Emer- 
gency Medical treatment.) 

Alcoholic Stomatitis 

Complaint. — "Sore tongue" "Sore gums." 
Symptoms. — Tongue hypersensitive. Tongue 
shows ulcers on sides and tip. Gingivae and mu- 
cous membranes very red, swollen and tender — 
sometimes ulcerated. Somewhat resembles Vin- 
cent's infection. Tongue swollen, red, sore, and 
has impressions of teeth on sides and tip. Seen 
in heavy drinkers (alcoholic pellagra). 

Treatment. — 1. Multiple vitamin therapy. 
(Hexa vitamin, tabs 1 t. i. d.) 

2. Encourage strict oral hygiene. 

3. Assure that patient receives an oral prophy- 
laxis and instruction in oral hygiene. 

4. Discourage consumption of any alcoholic 
beverages. 

Infectious Stomatitis 

Complaint. — "Sore mouth." 

Symptoms. — Fiery red mucosa. (See pi. II- 
A) Accompanying nasal, throat, and bronchial 
catarrh. Usually acute. Early itching sensations. 
Cheeks may be involved, also palate. Tongue and 
lips may be swollen. Increased pain when eat- 
ing. Tender regional lymph nodes. Fever 102°- 
104° F. Sore throat, foul breath. 

Note. — May be complicated by Vincent's infection. 



PLATE 2 



132a 





FIRST AID AND EMERGENCY PROCEDURES 



133 



Treatment. — 1. Mild mouthwashes with sodium 
bicarbonate and water (2 percent Bolution). 

2. Reduce or eliminate smoking. 

3. Apply protective ointment t<> lips as indi- 
cated. 

I. Improve general body resistance through 
diet, lluid>. etc. 

.'>. Treat fever with antipyretic (aspirin, .*> 
grains, <i I h). 

6. Bed rest. 

7. Gargles and mouthwashes as appropriate. 




Figure 118. — Infectious Stomatitis. Mucosa fiery red. Gingiva, 
lips and tongue may be swollen. 



Non-Infectious Stomatitis 

Complaint. — '"Sore and painful mouth." 
Symptom. — Inflamed mucosa, redness and 
swelling of gingivae. Desquamation of epithel- 
ium. Tissues look burned. May be chronic — 
usually acute. 

Treatment. — 1. Reduce or eliminate smoking. 




Figure 119. — Non-Infectious Stomatitis. Gingiva appears slightly 
red and swollen, entire mucosa inflamed and raw. Isolated 
areas may desquamate as illustrated. 



2. If due to ill-fitting demure-, remove per- 
manently and i real with mild alkaline mouthwash 
i •_' percent solution Bodium bicarbonate). 

:'». Advise patienl to avoid hot foods or irritants. 

1. [f due to toothache re lies (chemical burns, 

aspirin, etc) instruct patient to avoid their 

5. Edema is reduced bj Bucking ice. 

6. Ajrrange for treatment of dental defects. 

Aphthous Ulcer Canker Sore Dyspeptic Ulcer 
Complaint. M Ulcer(s) or -ore- in mouth." 
Symptoms. — Round or oval, greyish ulcers 2 8 

mm. in diameter. iua\ coalesce W ith Others to form 
large and irregularly Bhaped ulcer. Each lesion 




Figure 120. — Aphthous Ulcers may be found anywhere in oral soft 
tissues. Small greyish ulcers may coalesce with others to form 
a large irregularly shaped ulcer. 

is surrounded with reddish halo. (See pi. II. 1">. i 

Very painful, may accompany gastrointestinal 

upsets. Rare on soft palate but may he -ecu any- 
where on -oft tissues of mouth. May tend to recur. 
Usually heals without treatment in 7 to 10 da\ -. 

Treatment. — 1. Pain may be relieved by care- 
fully touching ulcer with very small drop of sil- 
ver nitrate and following immediately with a 
drop of eugenol to stop the caustic action of silver 
nitrate. 

•2. Avoid acid food- and irritants (mustard, 

Catsup, lemon juice, etc. I 

3. Encourage increased fluids and substantial 

diet. 

Traumatic Ulcer 

Complaint. — "Sore in mouth." 

Symptoms*— History of trauma by instru- 
ment, tool, pencil, toast, hone, toothhru-h. or hir- 
ing of tongue, cheek, or lips. Abraded or la 

atetl mucosa. Palate i- common - Mi> be 

secondarily infected by mouth organisms to form 
an ulcer with a definite border and crater re- 



81 1866*— 53- 



-10 



134 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 121. — Traumatic Ulcer of Tongue. An initial traumatic 
lesion of oral mucosa may become infected to form this ulcer 
which resembles an aphthous ulcer. 

sembling an aphthous ulcer. Duration, 3 to T 
days. 

Treatment. — 1. Alkaline aromatic solution 
tablets (1 tablet in glass warm water as mouth- 
wash). 

2. Instruct patient in oral hygiene. 

3. Proper diet of bland foods. 

4. If rough tooth is cause, smooth area with 
small piece of sandpaper. 

5. Observe carefully for normal healing. 

Acute Pericoronitis 

Complaint. — "Sore wisdom tooth" "Gum 
around wisdom tooth sore." 

Symptoms. — Gum tissue in area of third molar 
inflamed. Difficult to open and close jaw. Short 
history — spontaneous onset. May be complicated 
by Vincent's infection. Coated tongue and odor. 
Sometimes fever. May develop cellulitis or peri- 
tonsillar abscess. 

Treatment. — 1. Relieve pain with analgesic 
(aspirin, 5 grains, or APC, 5 grains, prn). Local 




application of counterirritants may be helpful 
(tincture of benzoin compound). 

2. Frequent mouthwashes and gargles with 
warm or hot saline solution. 

3. Institute antibiotic therapy (penicillin, 
crystalline G 300,000 U every 12 to 24 hours intra- 
muscularly). 

4. If Vincent's infection present, treat accord- 
ingly. 

Pericoronal Abscess (Infection) 

Complaint. — "Sore wisdom tooth" "Gum 
around wisdom tooth sore." 

Symptoms. — Pus may be present. Swelling 
more pronounced, pain less than acute pericoro- 
nitis. Longer history — may have had one or 
more previous acute infections. 




Figure 123. — Pericoronal Abscess. Large local swelling. Pus may 
be present. A small pellet of cotton moistened with Tincture 
of Benzoin compound may be locally applied to area shown. 



Figure 122. — Acute Pericoronitis. This condition is more commonly 
observed in the mandibular third molar area. 




Figure 124. — Perico 
by inserting shor' 
of tissue as shown 



onal Abscess. Drainage may be improved 
strip of iodoform gauze under swollen flap 



FIRST AID AND EMERGENCY PROCEDURES 



135 



Treatment. — 1. Provide drainage by carefully 

inserting a short strip of iodoform gauze as a 
"wick." (See fig. 121.) 

2. Fluids. 

3. Institute antibiotic therapy (penicillin, 
crystalline G 800,000 every 12 to 24 boura intra- 
muscularly. 

4. Frequent mouthwashes and gargles with 
warm or hot saline solution. 

Denture Stomatitis (Nontraumatic) 

Complaint. — "Sore mouth under denture." 
Symptoms. — Mucous membrane that is covered 
by dentures appeals inflamed. Gingivae appear 
raw and sore. General oral hygiene poor or 
neglected. 




Figure 125. — Denture Stomatitis (Nontraumatic). Oral mucosa 
raw-looking in regions covered by dentures. Inflammation may 
be particularly intense in certain areas about teeth. 

Treatment. — 1. Thoroughly scrub dentures 
with soap and water and place in a saturated solu- 
tion of sodium bicarbonate overnight. 

2. Instruct patient to maintain strict oral 
hygiene. 

3. Avoid hot and irritating foods. 

4. Leave dentures out of mouth during healing. 
6. Maintain absolute cleanliness of dentures. 

Denture Stomatitis (Traumatic) 

Complaint. — "Sore mouth under denture." 
Symptoms. — Mucosa normal except in specific 
area of soreness. Patient usually complains that 
dentures do not fit properly. Ulcers may he pi 
ent in area of irritated mucosa. Soreness may he 
at edge of denture or under it. Denture may be 
cracked or hroken. 



Treatment. -1. Leave denture out of a 
during healing. 

•J. Carefully paint area with tincture of benzoin 

compound. 

.".. Only a dental officer should remove traumata 
genie area of dentin a 




Figure 126. — Denture Stomatitis (Traumaticl. local areas of in- 
flammation are associated with traumatic injury from ill-fitting 
dentures. Ulcers may result when these areas become infected. 

Marginal Gingivitis 

Complaint. — "Sore gums' 1 "Bleeding gums.'' 
Symptoms. — Usually localized inflammation in 

gingival area between the teeth: may be pp 

in more than one location or may be general. 

Teeth in area of inflammation may he carious: 

food may he impacted in carious Lesions between 
the teeth. Gingivae appear red and swollen at 

their margin. Pressure upon reddened area- 
cause'- slight bleeding. Tooth alinement may be 
faulty allowing food impaction and presenting 
proper cleansing. Brushing of teeth usually 
causes bleeding. Soreness, but not pain. 

Gingivae are smooth, red. and glistening rather 
than pink and -tippled. 



i . i i ii ' ■ ' ■ ' ' ' ' ■ i 
I 




Figure 127. — Normal appearance of gingiva about necks of teeth. 



136 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 128. — Marginal Gingivitis. Local swelling of gingiva in 
one or more areas between teeth. Slight bleeding may result 
when these areas are touched. 

Treatment. — 1. Carefully remove impacted 
food by using dental floss. 

2. Irrigate area with warm water or warm 
saline solution. 

3. Paint area with mild tincture of iodine, 
U. S. P. 

4. Advise patient to avoid consumption of irri- 
tating and spicy foods and stringy meats which 
tend to catch and hold between the teeth. 

5. Prescribe frequent saline mouthwashes. 

6. Advise patient to avoid gingivae when brush- 
ing the teeth until condition has improved. 

7. Ascertain dietary habits and correct if indi- 
cated. 

Mild Gingivitis 

Complaint. — Bleeding gums — When I brush 
my teeth, or eat an apple, etc. 

Symptoms. — Slight bleeding when gingiva 
touched. Carious teeth may be present as they 
provide focal point for infection. Slight tender- 







ness. Sucking on gums may produce bleeding. 
Usually oral hygiene is neglected or mucosa has 
been irritated by prolonged smoking and/or drink- 
ing alcoholic beverages. If bleeding is of long 
duration, patient may have hemorrhagic history. 
Treatment. — Usually due to local causes — 
hence : 

1. Instruct patient to brush teeth thoroughly 
and frequently. 

2. Frequent use of a mild alkaline mouthwash 
(2 percent solution sodium bicarbonate). 

3. Instruct patient to stimulate gums with finger 
massage. 

4. Avoid irritants — check diet and vitamin 
intake. 

5. If bleeding is of long duration, refer to a 
dental or medical officer at the first opportunity. 

Vincent's Infection 

Complaint. — "Bleeding gums" "Trench mouth." 
Symptoms. — Severe soreness and bleeding of 
gums and bad taste in mouth. (See pi. II, C.) 
Low resistance of oral tissues probable predispos- 
ing factor. Fever of 99° to 102° F. Gingivae be- 
tween the teeth are red and swollen, or necrotic 
with a greyish slough. Eemoval of necrotic mem- 
brane leaves bleeding surface. Hemorrhage may 
result during act of rinsing mouth with water. 
Evidence of poor oral hygiene usually — progress 
of disease prevents good oral cleanliness. In- 
creased flow of saliva ; drooling. General feeling 
of depression. Foul odor to breath. Adenopathy 
may be present. Persists for many days — even 
months, if no treatment rendered. May be a com- 
plication of pericoronitis. 




Figure 129. — Mild Gingivitis. Gingival margins slightly swollen 
and inflamed. Bleeding from gingiva on sucking. Gum tissue 
below gingiva not involved. 



Figure 1 30. — Early Vincent's Infection. Gingiva between teeth 
inflamed and tender. There is poor oral hygiene. Brushing 
teeth causes bleeding. 



FIRST AID AND EMERGENCY PROCEDURES 



137 




Figure 131. — Late Vincent's Infection. Gingiva between teeth 
and later around teeth become neucrotic with characteriitic 
greyish slou ;hinq. Bleeding occurs with slightest irritation and 
gingiva are very painful. 

Treatment. — 1. See patient daily during acute 

^l at r ( I to 7 days). 

2. ( 'lean teet h. gingival i issue and mucous mem- 
brane with hydrogen peroxide solution, l\ S, P., 
."> percent, using swabs or pellets 

3. Penicillin troches containing 5,000 units, may 
be prescribed, one troche each hour. 

4. Frequent oral rinsing with a solution of Hy- 
drogen Peroxide and water. (Two teaspoons hy- 
drogen peroxide solution, TJ. S. P., •"> percent in 
half <ila>s water.) 

5. Bed rest advised. 

6. Balanced diet, supplemented with vitamins 
(multiple) (Hexavitamins tabs., 1 o. d.). 

7. Laxative if necessary. (Cascara Sagrada, •"> 
to 15 grains). 

8. Refrain from brushing during acute (febrile) 
Stages. Discontinue smoking. 

!». Antipyretic for fever (aspirin 5 grains 
(,4h). 

Vincent's Angina 

Complaint. — "Sore mouth, mini.-, and throat." 
Symptoms. — Fever to 104° F. Gingivae, cheek, 
side of tongue, fauces, and tonsils may be involved : 
infection may be confined to throat alone. Large 
ulcers with greyish-brown surfaces. Membrane 
firmly attached. May be complicated by perio- 
dontal disease (pyorrhea). Thought to be second- 
ary infection only. Predisposition must be 
present. 

Treatment. — 1. Measures to improve local tis- 
sues : 



'/. Advise frequent mouthwash and 
with hydrogen peroxide, l. 8. P., 
diluted to half -i rength with water. 

b. Judicious and careful oral hygiene. 

c. Avoid irritants, 

-. Measures to improve systemic conditio! 

". Balanced diet and force fluids. 

b. Antibiotic (penicillin, crystalline 6^00,000 
D everj 12 toSM how 
Best. 

d. Improve elimination with mild laxativi 
necessary. 

Dry Tongue-Burning Tongue 

Complaint. — "Dry. burning tongue.' 1 
Symptoms. — A symptom of many systemic dis- 
eases — pellagra, pernicious anemia, disturbs] 
of gastric Becretion and psychoneurosis. Some- 
times present in -hock and severe hemorrhage. 
Indicate- state of dehydration. Look for local ir- 
ritations from dentures, restorations. 

Treatment. 1. Attempt to find underlying 
cause of systemic or irritations] origin. 

2. Proper diet. 

3. Treat for shock if necessary. 

4. Force fluids. 

."). Advise mild alkaline mouthwashes, 1 1 aBolve 
one tablet (alkaline aromatic solution, tablet-) in 
a glass of water. l'-e a- mouthwash four time- 
daily. 

Herpes (Labialis) 

Complaint. — "Fever bli-ter-"' "Cold -on-.'* 
Symptoms. — Burning sensation is early symp- 
tom. Early swelling of a local lip area to form 




Figure 132 — Herpes Labialis. Small blister-like vesicle on lip. 
May coalese with others to form cluster, late stages show 
crusting and desquamation of lip mucosa. 



138 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



small vesicles. Vesicles may form in clusters. 
Crusting and desquamation of mucosa. 
Treatment. — 1. Check patient for fever. 

2. Check patient for influenza. 

3. Apply spirits of camphor locally 3 to 4 times 
a day. 

4. Avoid exposure to sun. 

Cheilitis (Cheilosis) 

Complaint. — "Sores at corner (s) of mouth." 
Symptoms. — Begins as redness and peeling of 
skin at angles of mouth. Cracks in skin occur as 
peeling continues. Similar lesions often seen at 
the naso-labial groove. Often associated with pro- 
longed nutritional deficiencies. Often subject to 
secondary infection from saliva and skin 
contamination. 




Figure 133. — Cheilitis. Begins as redness and peeling at corner 
of mouth. Skin cracks to give characteristic appearance of this 
inflammation. 

Treatment. — 1. Prescribe riboflavin tablets in 
dosage of 2 milligrams (0.002 gm.) five times a day. 

2. Apply protective ointment to involved area. 

3. Attempt to prevent secondary infection by 
strict cleanliness, care in shaving, and discrimi- 
nate eating habits. 

4. If infected, cleanse daily with soap and water 
and apply anesthetic ointment containing butyn 
and metaphen. 

5. Adequate diet essential ; increase fluid intake 
and maintain proper bowel function. 

ODONTALGIA— TOOTHACHE 

Toothache or odontalgia is a typical response of 
the dental pulp to irritation, inflammation, or in- 
fection. Stimuli which are responsible for the 



production of pain are of varying types : chemical 
(drugs, food, liquids, etc.), traumatic (blow, un- 
even occlusion, high fillings), dental caries (tooth 
decay), which may in itself irritate or infect the 
dental pulp. Other conditions which are usually 
manifested by symptoms commonly attributed to 
toothache are also included in this category. 

Erosion or Hypersensitive Dentin 

Complaint. — "Simple toothache." 

Symptoms. — Neck of tooth is sensitive when 
touched with toothbrush bristles or fingernail. 
Tooth may also be sensitive to sweets and/or fruit 
juices. Tooth may appear to be wearing away at 
gingival margin. 

Treatment. — 1. Apply sodium bicarbonate 
paste over sensitive area. (Thick paste of water 
and sodium bicarbonate), or paint glycerin over 
dried sensitive area. 

2. Advise use of alkaline toothpaste. (Thick 
paste of water and sodium bicarbonate). 

3. Avoid irritating foods. 




Figure 1 34. — Erosion at "neck" of tooth. Area sensitive to touch. 

Simple Pulpitis or Sub-Acute Pulpitis 

Complaint. — "Simple toothache." 

Symptoms. — Irritation may be produced by 
sweets and either hot or cold liquids. Sharp, 
throbbing, intermittent pain. Pain may increase 
when reclining. Not painful to percussion. 
Cavity may be visible (fig. 135). There may be a 
loose or broken filling in tooth. 

Treatment. — 1. Carefully remove debris from 
carious tooth with excavator or remove loose filling 
(fig. 136). 



FIRST AID AND EMERGENCY PROCEDURES 



139 




Figure 135. — Beginning Caries. Simple Pulpitis. Tooth is slightly 
sensitive to cold or hot liquids and sweets. 




Figure 136. — Simple or Sub-Acute Pulpitis. Remove caries and 
debris with excavator. 



V.fJ; 




Figure 137. — Flush cavity with warm water. 




2. Washout cavity with warm water (fig. 

•\. Dry cavity with clean cotton pellet (fig. 
Insert another small pellet moistened with eugenol 
(fig. 189). 

4. Fill cavity with sine oxide ;in<l eugenol paste 
a- temporary filling i li^ r . 140). 

Noii.— Mix /mi- oxide powder «iili two drope eugenol 
mi kI:i --: Blab or paper pad add enough alnc oxide i" 
make a putty-like conaiatency. 

.'.. Analgesic as indicated ( A l'( . .'- grains pin. i. 




Figure 139. — Insert cotton pellet moistened with eugenol into 
cavity. 




Figure 138. — Dry cavity with cotton pellet. 



Figure 140. — Fill cavity with paste of line oxide ond eugenol. 

Acute Pulpitis 

Complaint. "Severe toothache". \. 
Symptoms. — Tooth usually -how- extensive 
caries, large restoration, or ha- history of trauma 

(fig. nil. Dull or severe, continuous pain. 
Heat increases pain; cold relieve- as pulpal infec 
tion increases i iij. r . 146). Tain usually more 

seven- when food impact- in cavity. Later, tooth 
may be tender to percussion. 



140 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Treatment. — 1. With excavator remove as 
much debris from cavity as possible. 

2 a. If pain increases suddenly, discontinue and 
insert 1-2 drops of eugenol and cover with zinc- 
oxide and eugenol paste. Do not pack (figs. 142, 
143, 144, 145) . 





Figure 144. — Dry cavity with cotton pellet and insert cotton dress- 
ing moistened with eugenol. 



Figure 141.— Deep caries with pulpal exposure. Acute Pulpitis. 
Irritable to any temperature change and food impaction. 





Figure 145. — Fill cavity with soft paste of zinc oxide and eugenol. 
Do NOT Pack. 



Figure 142. — Carious — exposure. Acute Pulpitis. Remove as 
much caries and debris as possible. If sharp pain produced, 
stop immediately. 





Figure 143. — Wash out cavity with warm water. 



Figure 146. — Deep caries with pulpal exposure causing pulp 

death. Infection of pulp may extend beyond root and form 

abscess. Tooth sensitive to hot fluids, relieved by cold. Sen- 
sitive to percussion. 

b. If pain decreases upon removal of decay 

leave cavity open and insert pellet of cotton to 

prevent food from impacting (figs. 147, 148). 

3. Remove pellet and flush cavity with warm 

water at 24 hour intervals to keep cavity clean. 



FIRST AID AND EMERGENCY PROCEDURES 



141 




Figure 147. — Carious Exposure, 
caries and debris as possible, 
tinue caries removal. 



Pulp dying. Remove as much 
If pain stops suddenly discon- 




Figure 149. — Periapical Abscess resulting from deep caries and 
pulp death. Spontaneous drainage may be established through 
fistula and "gumboil." 




Figure 148. — Wash out cavity with warm water and gently place 
cotton pellet at bottom of cavity. 

Place clean cotton pellet into cavity each tune. 
I. Analgesic as indicated (AIM '. ."> grains, pro.) . 

Acute Periapical Abscess 

Complaint.— "Severe toothache". B. 

Symptoms. — Same as A (above) except toothis 
always tender to touch and pain i> constant and 
throbbing. Face or jaw may be swollen in area of 
affected tooth. Tooth may be loose in socket. A 
Fistula or a "gumboil" may be present i lii:-. 149, 
150). ( See pi. II. 1). ) 

Treatment. — 1. Debris and soft dentin should 
be carefully removed with excavator. 

2 Open cavity to pulp — establish drainage 
from cavity. 

3. Flush with warm water and insert pellet of 
cotton into cavity to prevent food impaction. 

4. If no cavity is visible, use ant ibiot ics. ( Pen- 
icillin, crystalline G 400,000 U every 12 to 24 hours. 
Anieuinyein, 500 mg. Mat. and 250 mg. q 6 h. not to 




Figure 1 50. — "Gumboil" developed from periapical abscess. 
Note position as compared with that of a periodontal abscess. 




Figure 151. — "Gumboil" developed from a periodontal abscess. 

I :'. days.) Fistula may not form if anti- 
biotic- are used. Never incise for drainage. 
."'. Analgesic as indicated. (A PC. ."> grains, or 

codeine. ' _. grain, pro.) 
(;. Repeat item S daily. 



142 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Periodontal Abscess or "Pyorrhea" Abscess 
Complaint. — "Severe toothache". C. 
Symptoms. — Cavity may not be present. In- 
flammation of gingiva about tooth or teeth. Tooth 
may be loose. Painful to touch and feels elon- 
gated to patient on closure. Swelling and "gum- 
boil" closer to crown than with apical abscess. 
Deep pocket about tooth often produces pus. If 
adequate drainage is present a "gumboil" will not 
form. (See pi. II, E.) Tooth not painful to 
heat or cold. 




Figure 152. — Periodontal Abscess. Pocket formation along side 

of root is followed by infection and formation of fistula and 

"gumboil". Drainage may also be established at gingival 
margin. 

Treatment. — 1. Have patient hold hot saline 
solution in mouth every 15 minutes. 

2. Paint adjacent area with mild tincture of 
iodine as counterirritant. 

3. When pus appears at gum margin or through 
fistula, encourage continuous, free drainage with 
sterile, blunt-tipped instrument. 

4. Continue vigorous mouth rinses to keep 
pocket clean. 

5. Analgesic as indicated. (APC or codeine, 
i/ 2 grain, prn.) 

TRAUMATIC INJURY 

Trauma to structures of the mouth may affect 
the tooth, the supporting or investing tissues of 
the teeth (bone and membrane of the periodon- 
tium), or the jawbones. Such injuries may occur 
from blows, wounds (gunshot and others), falls, 
uneven bite relationship and bizarre injury to oral 



tissues from pencils, toothpicks, food impactions, 
burns, etc. 

Jaw Fracture 

Complaint.— "Broken jaw'' "Teeth out of line" 
"Blow to jaw — cannot bite as before." 

Symptoms. — Localized pain. History of 
trauma. Difficult or impossible to open or close 
mouth. Hemorrhage may be present. May be 
loose or broken teeth present. 

Treatment. — 1. Do not manipulate bone ends 
unless there is hemorrhage. To stop hemorrhage 
it may be necessary to carefully manipulate jaw 
with fingers to move bone ends into proper posi- 
tion (fig. 153). Immobilize. 




Figure 153. — To control hemorrhage in area of fracture if may be 
necesary to attempt careful repositioning of the fractured parts 
until teeth can be brought together properly and jaws immobil- 
ized. 

2. To immobilize see figure 154, 155, 156. Keep 
bandage well forward to prevent impingement 
on airway. 

3. Narcotics and analgesics for relief of pain. 
(Morphine sulfate, % to 14 grains, IM; or 
codeine, % grain, prn. and APC.) 

4. Bed rest. 

5. Liquid diet. 

Fractured Tooth 

Complaint. — "Broken crown of tooth." 

Symptoms — Type I. — Portion of tooth crown 
lost but pulp not exposed. Tooth not loose. 
Tooth very sensitive to air and temperature 
changes. 

Treatment. — 1. Exposed surface may be dried 
and coated with collodion. 

2. Smooth sharp edges with sandpaper. 



FIRST AID AND EMERGENCY PROCEDURES 



143 




Figure 154. — Modified Barton bandage for immobilization of jaw 
fractures. 




Figure 156. — Seaman's cap may be used in emergency by cutting 
away a portion of brim and positioning as illustrated. 





Figure 155. — Four-tailed bandage for immobilization of jaw 
fractures. 



Figure 157. — Type I Fractured Tooth. Small portions of crown 
broken. No pulpal exposure. Slight sensitivity. 

Fractured Tooth 

Complaint— "Broken crown <.f tooth" (con- 
tinued ). 

Symptoms.— 7' v/" 11. -Sufficient portion <>f 
tooth ln>i to expose pulp slightly i fig. 168). I 
not loose. Very painful to air or temperature 
changes. Difficult to masticate food without caus- 
ing pain. 



144 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 158. — Type II Fractured Tooth. Slight exposure of pulp. 
Very painful to thermal changes and to touch in exposed 
areas. 

Treatment. — 1. Cover area with a zinc oxide 
and eugenol and cotton fiber splint (figs. 159, 160.) 

2. Place on bland diet until inflammation sub- 
sides. 




Figure 159. — Addition of cotton fibers to mix of zinc oxide and 
eugenol provides more bonding strength. 




Figure 160. — Splint of zinc oxide and eugenol paste containing 
cotton fibers. 

Fractured Tooth 

Complaint. — "Broken tooth" (continued). 

Symptoms — Type III. — Large fracture of 
crown, exposing large portion of pulp. (See pi. 
II, F.) Tooth not loose. Very painful to air, 



fluid, and mastication on exposed pulp. Pulpal 
hemorrhage usually present. 

Treatment. — 1. Make large splint of zinc oxide 
and eugenol with cotton fibers and place over 
lingual and labial of tooth. Allow to harden for 
several hours (fig. 159). 

2. Advise bland diet. 




Figure 161. — Type III Fractured Tooth. Pulp well exposed re- 
sulting in hemorrhage. Extremely painful to touch and thermal 
changes. 




Figure 162. — Type IV Fractured Tooth. Root fractured. May be 
complicated with break in crown. Tooth mobile. 

Fractured Tooth 

Complaint. — "Loose tooth from fall or blow." 

Symptoms — Type IV. — Tooth loose with or 
without fracture of crown (fig. 162). Root of 
tooth may be fractured. Thermal reactions de- 
pendent upon presence and extent of any coronal 
fracture. Tooth may be painful to movement. 

Treatment. — 1. Make splint of zinc phosphate 
cement for labial or buccal and lingual of tooth, 
if pulp is not exposed. Or make splint with zinc 
oxide and eugenol and cotton fiber (fig. 163). 

2. Advise bland diet. 



FIRST AID AND EMERGENCY PROCEDURES 



145 




Figure 163. — Splint of zinc oxide and eugenol paste containing 
cotton fibers covers wider area over teeth and gums. 

Chemical Burn 

Complaint. — "Sore mouth" "Burned mouth." 

Symptoms. — Frequently caused by placing as- 
pirin against gum tissue to stop toothache. White 
pjaque on mucous membrane. Painful. 

Treatment. — Paint a 1 percent aqueous solution 
of crystal violet to area twice daily to prevent 
secondary infect ion. 

2. Advise patient thai aspirin should be swal- 
lowed if used at all. Other so-called "remedies" 
also may bo harmful. 

Thermal Burn 
Complaint.— "Sore mouth" "Burned mouth." 
Symptoms. — Often due to hot fluids having 

burned the mouth. Generally affects tongue and 

palate. Desquamation of tissue in severe burns. 

Treatment. — 1. Apply anesthetic dental oint- 
ment (Butyn 4 percent. Metaphen 1 : 1500) to 
tender areas for relief of pain. 

2. Paint a 1 percent aqueous solution of gentian 
(crystal) violet to the area twice daily to reduce 

chances of secondary infection. 

SERIOUS DENTAL INFECTIONS 

Infections of the mouth, teeth, or supporting 

structures can spread to and seriously affect far 

removed regions of the body. Any evidence- of 
Swelling aboul the jaws and neck area, particu- 
larly if accompanied by fever and malaise, should 

receive prompt professional treatment. Antibi- 
otics and chemotherapy in adequate dosage, bed 

rest and substantial diet should he applied. Con- 
sideration should he given to immediate transfer 

of the patient for definitive I reatment. 



Cellulitis, Peritonsillar Abscess, Ludwig's 
Angina, Acute Osteomyelitis or Cavern- 
ous Sinus Thrombosis 
Complaint. "•Swollen jaw." 
Symptoms. Rapid swelling over the de of 
the face to the neck if cause is of mandibular origin 
i fig. L64). I f t he cause is of maxillary origin t be 

BWelling may extend to the eye (fig. I<''">>. Skin 
pit- on pressure. Become- \f(\ as inflammation 

localizes. Pain severe, ranging from acute and 

sharp to throbbing. Temperature may be ele- 
vated to 106 F. Rapid pulse. Trismus. Often 
associated with pericoronitis, periapical or perio 
dontal absce 




Figure 164. — Serious Denial Infections of mandibular (lower jaw) 
origin result in extensive swelling over side of face and neck. 




Figure 16S. — Serious Dental Infections of maxillary (upper jaw) 
origin result in extensive swelling over side of foce to the 
eyes. 



146 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Treatment. — 1. Intramuscular penicillin, crys- 
talline G (300,000 U every 12 to 24 hours). 

2. Hot magnesium sulfate dressings to local- 
ize infection. 

3. Confine to bed. 

4. Soft diet. 

5. Force fluids. 

6. Warm saline mouthwash every hour. 

POSTSURGICAL EMERGENCIES 

Not uncommon are emergency conditions fol- 
lowing tooth removal or other surgical operations 
within the mouth. Secondary hemorrhage may 
result from trauma, blood dyscrasia, infection, ir- 
ritation by foreign elements, malignancies, or an 
absence of normal clotting elements. Pain can be 
expected to accompany even the simplest of tooth 
extractions since tissue and bone are traumatized 
as a result of the operation. 

Primary Hemorrhage 

Complaint. — "Bleeding from tooth socket" 
Symptoms. — History of recent extraction one 

or more hours previously. Little or no pain. 

Some soreness in area. Large clots of blood. 
Treatment. — 1. Gently remove large clots with 

blunt-nose forceps. 

2. Insert 2-inch gauze pad directly to area and 
have patient close with- firm pressure for 10 to 15 
minutes. Use as many gauze pads as necessary to 
provide the necessary pressure. 

3. Advise patient to be cautious about any phys- 
ical exertion for a few days. 

4. Repeat treatment frequently if necessary. 

5. Advise no mouth rinses. 

Secondary Hemorrhage 

Complaint. — "Bleeding from tooth socket." 
Symptoms. — History of tooth extraction one or 

more days previously. May be pain. 

Treatment. — 1. Analgesic for pain (APC, 5 

grains, prn). 

2. Gently remove large clots with blunt-nose 
forceps. 

3. Soak 2 by 2-inch gauze pad in epinephrine 
(1: 1000), and have patient bite firmly thereon as 
above. 

4. Bed rest with head in slightly elevated 
position. 



Sequestra 

Complaint. — "Sharp points in area of recent 
extraction." 

Symptoms. — History of recent extraction. 
Cheek or tongue in adjacent area may be irritated. 
Sharp bone spicule(s) may protrude through gum 
tissue. Spicule may be loose or fixed. 

Treatment. — 1. Apply antiseptic to area (meta- 
phen tincture.) 

2. If bone spicule is loose, gently remove with 
cotton pliers or hemostat. 

3. If bleeding results, treat as primary hemor- 
rhage by having patient bite on gauze pad for 
5 to 10 minutes. 

Dry Socket 

Complaint. — "Pain in tooth socket," "Pain ,in 
side of face," "Bad odor from socket." 

Symptoms. — History of recent tooth extrac- 
tion — 3 to 5 days. Severe pain. If clot normally 
found in socket is absent, bare bone will be visible. 
Food debris sometimes fills the socket. If any 
portion of a clot is present, it appears fragmented 
and discolored (dark). Bad breath. 

Treatment. — 1. Irrigate socket with warm 
water or saline solution (fig. 167) . 

2. Gently dry socket with cotton pellets, then 
carefully insert into socket a strip of iodoform 




Figure 166. — Dry Socket following extraction of tooth. In absence 
of debris or discolored clot, bone of alveolus or socket 
exposed. 




Figure 167. — Socket flushed gently with warm saline solution. 



FIRST AID AND EMERGENCY PROCEDURES 



147 



gauze moistened with eugenol. Fill socket but 
do not pact i fig. L68). 

3. Analgesic for pain (AIM'. :, grains, prn, or 
codeine, ' - grain, pin ). 

4. Repeal treatmenl daily until patient can be 

seen by a I Vntal officer. 




Figure 168. — Iodoform gauze dressing moistened with eugenol is 
gently placed in dried socket. It must be changed every 24 
hours. Fill socket but do NOT cock. 

TUMORS 

Tumors are rarely painful in their earlier stapes 
so they will seldom be encountered iii first aid 

treatment. For any condition which doesn't re- 
spond to treatment within 48 hours make immedi- 
ate arrangements for an early examination by a 
dental officer. 

OTHER DENTAL CONDITIONS 

Included in this section are a few oral conditions 
which are seldom painful unless complicated by 
trauma or infection. The history associated with 
these conditions may be of lon<r or short duration. 
The history may be obscure since the patient may 
have noted presence of the condition by accident 
only after it had been traumatized. Generally 
speaking, palliative t reatment only is indicated for 
this category until patient can be referred to a 
dental officer for consultation and or treatment. 

Hairy Tongue I Black tongue) 

Complaint. — "Tongue is black." 

Symptoms. — History of long or short duration. 
Not associated with food or medicant ingestion. 

Xon-painful. Surface stained light brown to 
black. Surface has a furlike coat which frequently 
tickles the palate 



Treatment. I. Three percent hydrogen i 

ide painted on tongue -urface may remove much 

of the discolorat ion. 

Obstructive Salivary Calculus 

Complaint. "Swollen jaw." 

Symptoms. — Swelling <>f face in front .,; 
or below mandible. At mealtime swelling enlai j 
and i- painful. Swelling gradually reduce- after 

the al. M:i\ resull in an infection of salivarj 

duct and gland. 

Treatment. 1. Have patient observe strict oral 
hygiene. 

2. If swelling persists, use frequent hot saline 
mouthwashes. 

">. If in ic.ti. m i- present, characterized by high 
fever, administer antipyretic (aspirin, ■"» grains, 
-lib). 

•1. Apply antibiotics. 

5. Analgesics for pain, if necessary. 

0. Inject penicillin (crystalline (J) :500,000 u n i t s 
intramuscularly <i 12 or -_'l h i. 

Geographic Tongue 

Complaint. — "Bed patches on tongtn 
Symptoms. — History of condition is indefinite. 

Patient may have noticed condition only recently. 
Tongue papillae in red areas appear absent Non- 
painful except upon ingestion of Specific food- 
known to patient. Ass patient to watch for 
change in position and size of reddened ami ir- 
regularly shaped /.one-. 

Treatment.- -1. No treatment. 

2. Patient should avoid irritating foods. 

Torus Palatinus 

Complaint. — "Pump on roof of mouth." 

Symptoms. — History of being present for many 
year- or patient may have noticed condition only 
recently. Shape i- round to irregular and i> found 
in midline of hard palate. Peels hard and bone- 
like. No inflammation present unless injured by 
toothbrush or other foreign object. Non-painful. 

Treatment. — l. No t reatment, 

2. Reassure patient, but have dental officer con- 
firm diagnosis. 

:',. It bruised or irritated, treat locally with 
tincture of InMizoin compound. 



48 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 169. — Torus Palatinus. Round or irregularly shaped bony 
lump at midline of palate. Does not change shape or enlarge. 
No associated complaint unless mucosa is traumatized. 

Torus Mandibularis 

Complaint. — "Lump(s) on inside of jawbone." 
Symptoms. — History same as for Torus Palati- 
nus. Shape is round or oblong. Found protrud- 
ing from jaw toward tongue on each side. 
Treatment. — 1. Same as above. 




Figure 170. — Torus Mandibularis. Similar to Torus Palatinus but 
found on inside of lower jaw as illustrated. 



REFERENCES 

Burkett, L. W. Oral Medicine. J. B. Lippin- 
cott Co., Philadelphia, 1946. 

Collidge, E. D. Clinical Pathology and Treat- 
ment of the Dental Pulp and Periodontal 
Tissues. Lea and Febiger, Philadelphia, 1946. 

Fry, W. K., et al. The Dental Treatment of Max- 
illofacial Injuries. J. B. Lippincott Co., Phila- 
delphia. 

Goldman, H. M. Periodontia. C. V. Mosby Co., 
St. Louis, 1942. 

Grossman, L. I., ed. Lippincott' s Handbook of 
Dental Practice. J. B. Lippincott Co., Phila- 
delphia, 1948. 

Grossman, L. I., Boot Canal Therapy. Lea and 
Febiger, Philadelphia, 1950. 

Handbook of the Hospital Corps, United /States 
Navy. The Bureau of Medicine and Surgery. 
Washington, D. C, 1939. 

Mead, S. V. Oral Surgery. C. V. Mosby Co., 
St. Louis, 3d edition, 1946. 

Thoma, K. H. Oral and Dental Diagnosis. W, 
B. Saunders Co., Philadelphia, 1949. 

Thoma, K. H. Oral Patholopy. C. V. Mosby 
Co., St. Louis, 2d edition, 1944. 



Chapter IV 

NURSING AND NURSING PROCEDURES' 

ORIENTATION TO NURSING AND NURSING PROCEDURES— UNIT I 



The scope of the material presented in the nurs- 
iiig seel ion is limited to i hose activities which the 
corpsman will most likely encounter in a sick bay 
or hospital ward. It is further limited to the 
"how" ami "what" to do and the reader is referred 

to other sections <>t' the handl k for the "whys." 

In this manner it is hoped thai the corpsman will 
more readily see the relationship of the sciences 
to the cart' of his patients and the relationships 
of sections to one another and thus obtain the 
maximum benefit and use from this handbook. 

Objectives. — This section of the handbook was 
compiled with two objectives in mind: 

1. To provide the corp-man with a guide to use 
in the care of his patient. 

2. To provide a basis for the standardization of 
routine nursing procedures in our Naval hospitals. 

[n attempting to attain both objectives, we have 
presented the text in the form of procedures 
wherever possible. The element- of care for all 
patients are included in detail while the care of 
patients with specific condit ions is omitted or very 
limited. 

Nursing a- defined in this handbook is the care 
•riven to sick and injured people. Nursing pro- 
cedures are methods used in giving uursing care 
to these patient-. 

The purposes of nursing and nursing proce- 
dures are as follows : 

1. To maintain, promote, and restore the pa- 
tient's health. 

2. To protect the patient against contracting a 
new infect ion. a reinfection, or a new condition. 

:i. To assist in the cure of the patient'- disease 
or condition. To achieve these purposes it is 
necessary that the corp-man : 

1. Attend to the comfort of" the patient. 

•2. Prevent the spread of infection. 



".. Assist with or perform diagnostic and thera- 
peutic procedures a- ordered by tin- doctor. 

The Comfort of the Patient 

This mean- attention to the physical and men- 
tal comfort of the patient. I>\ attention i- meant 
the accurate observation of the patient"- need- 

and then doing something about them. "Make the 
patient comfortable" is not ordered by the doc- 
tor: it is up to the corp-man. This i- the ait of 
nursing. Making the patient physically comfort- 
able include- providing facilities for a clean 
patient in clean surroundings ; frequent change of 
position employing comfort device- when needed: 

attention to patient'- diet and elimination. Mak- 

ing the patient mentally comfortable includes 
keeping the ward quiet and cheerful: providing 
for the patient's rest and relazat ion; treating the 
patient a- a person; promoting his confidence in 
ward personnel, ami keeping him contented. 
Physical and mental comfort depend on each 
Other; hoth must be considered and remembered 

when planning a patient'- care. 

Prevent the Spread of Infection 

The patient come- to the hospital or -ick bay 
expecting to he relieved of his complaints. Ever] 

thing done for the patient must be directed to- 
ward relieving his complaint- without exposing 
him to a new condition or disease, All people are 

possible carrier- and all people are possible I 

tims of di-ea-e caused by living organisms. Be 
member that ! Yon are people! That i- the n 
son why yon are urged to get enough -leep and 
rest, why you are told to keep your body and 
clothes clean, and why washing your band- will 
be stressed throughout tin- section. 

The comfort of the patient and the prevention 

of tic spread of infection are measures required by 



1 Mucii of th.' material in this chapter wai compUed from tii" lectin ,( tenner nn.l | 

members of tin' (acuities of the Naval Hospital Corps Schools. 



149 



2118G«°— sa- 



il 



150 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 171. — The Doctor — Nurse — Corpsman Team. 



and for all patients and therefore are referred to 
as "Basic nursing care." 

Assist With or Perform Diagnostic and Thera- 
peutic Procedures 

All diagnostic and therapeutic procedures are 
prescribed by the doctor for each individual 
patient. In following the techniques of a proce- 
dure as outlined in this section, try to remember 
your patient is a person and adapt the procedure 
to his needs. 

CORPSMAN-NURSE-DOCTOR RELATIONSHIP 

This is a team. The officer-enlisted personnel 
relationship exists because the patient requires 



care. Therefore the primary function of the team 
is the care of the patient within the limit set by 
higher authority. 

The doctor is the captain of the team. He gives 
the orders and expects them to be carired out. 
He is responsible to the chief of his service for 
the care and treatment of his patients, the efficient 
operation of the ward, and the coordination of 
ward activities with other departments of the 
hospital. 

The nurse is the quarterback of the team. She 
determines how the doctor's orders are to be ex- 
ecuted. She is responsible to the doctor and 
senior nurse for the nursing care of her patients, 
the management of the ward, and the supervision 
and instruction of the corpsman. 



NURSING AND NURSING PROCEDURES 



151 



The corpsman is the halfback <>f the team. He 
carries oul the orders of the doctor in the manner 
designated by the nurse. He is responsible to the 
doctor mid thf Durse for the efficient care of his 
patient- and for carrying out his assigned duties. 

As on any team, there DlUSl he mutual respect, 

cooperation, coordination, and loyalty among 
team members. Bach musl appreciate mid under 

stand tin 1 other's role in the function of the team. 
When each member of the team know- where he 
lit- on the team, what he is to do on the team, to 
whom he is responsible on the team, and how he is 
io do his part on the team, all members take per- 
sonal responsibility for the team's product which 

is provision of the best possible care to. and for 
the patient. 

CORPSMAN-PATIENT RELATIONSHIP 

The corpsman is in close contact with the patient 
throughout his stay in the hospital or sick bay. 
The patient frequently Bret makes known his 
wants, worries, fears, and pains to the corpsman. 
The tact . kindness, considerat ion. and understand- 
ing the corpsman shows toward the patient and 
his problems will help build the patient's con- 



fidence in the ability of all -i< k baj and hospital 

personnel to return him to health and duty iii the 

- hi nt est possible t ime. 
The behavior of the corpsman toward his 

patient- should he — 

Friendly to all he familiar with none. 

Sympathetic to all -hou pn\ to none. 
Assuring to all discouraging to none. 

Kilic lent in all things be bungling in none. 

Fair and honest to all -.-how favoritism to 
none. 
( aim always -flustered never. 
Self-controlled always — flighty never. 

Soft-spoken always — boisterous never. 

Interested alwayi — indifferent never. 



Suggested Additional Reading — Unit I 

Manual of M> dical />• /«//•/ m> nt, 1949. 

Medical Department Orientation. Correspond- 
ence course prepared by the Bureau of Medicine 
and Surgery, L949. 

Render, Helena, Nursi P Hent Relationship m 
Psychiatry. New York: McGraw-Hill Book 
Company. Inc. 1947. 



BASIC NURSING CARE— UNIT II 



Basic nursing rare as considered in this hand- 
book consists of those environmental, hygienic, 
and supportive measures required by the patient 
for the promotion of his health and his protection 
against contracting any additional infection, dis- 
ease, and/or condition. 

The amount of care needed by the patient will 
vary with each individual. Some patient- will 
need complete care by the nursin«r personnel: 
some will need assistance with their own care 
while others will require only supervision and 
direction by the nursing personnel. 

Points to think about, to know and to practice 
when caring for your patient :- 

1. lie an example of good health. He dean, 
look clean, feel clean. Use good posture and body 
mechanics in performing activities for your pa- 
tient for you may teach your patient good health 



habits w hile he i- ill which, if practiced, will help 
him keep well after he leave- your care. 

•J. Gel to know your patient: how does he feel 
about his illness? lb- treatment? Other pa- 
tient-? Ward personnel! bind out what makes 
him "tick." 

:'>. l>e alert and ob-ervant. Learn to recognize 

sii_ r ns ;l nd symptoms, be alert to changes in the 
mental and physical condition of your patient. 

I'M- POUT eyes, ears, nose, and hand-. b'ead and 

understand the doctor's order-: if in doubt, con- 
sult the doctor or nui-e. 

4. He adaptable. Learn to adjust nursing 

to lit the individual need- of the patient. 

5. Be -killfnl. Learn the routine- of pro- 
cedures -o that they may be done with the lea-t 
discomfort to your patient. 



152 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



6. Know the "why" of what you are doing. 
Make frequent reference to other parts of this 
handbook to better understand the reasons under- 
lying the "how." 

7. Have a plan. Use your head to save your 
feet. Think out what you want to do, how much 
time you have to do it in, and the method or se- 
quence of doing it. Examine your plan : Is it safe 
for your patient? Will it be comfortable or add 
to the comfort of your patient? Is it the best 
way to save time, materials, and produce the de- 
sired effects or results? "Will your plan make it 
possible for you to do the best job you are capable 
of doing? 

8. Explain your plans to your patient. Tell him 
what you are going to do for him and how he 
may help to get the best results from the pro- 
cedure. 

9. Protect your patient and yourself. 

Use equipment that is in good working 
condition. 

Keep yourself, your patient and the ward 
clean. 

Wash your hands before and after each 
task. 

Consider all body discharges and excreta as 
possible disease carriers and handle them as 
such. 

Keep your patient's personal belongings 
within his unit. 

Use only clean utensils in caring for your 
patient; clean, sterilize or disinfect utensils 
after he uses them. 

Provide paper wipes and bags for patients 
having nose and throat discharges. 

Follow medical aseptic technique in the care 
of a patient with a communicable disease and 
surgical aseptic technique in the case of a patient 
with a surgical condition. 
Teach your patient the importance of : 

Personal cleanliness, particularly washing his 
hands. 

Covering his mouth and nose when he coughs 
or sneezes. 

Using only his own toilet articles. 

Getting the proper rest. 

Eating the proper diet. 

10. Grow in your job. Analyze your work each 
day — strive to do a better job each day. 



THE PATIENT'S ENVIRONMENT 

Review — Chapter VI, "Group Protection 
Against Disease" 

The ward is a unit of a hospital composed of 
a number of beds and other equipment necessary 
to provide service to and for the patients assigned 
to it. The ward may accommodate from 6 to 60 
patients at one time and should provide a pleasant 
cheerful environment for the patients and person- 
nel. The ward should be orderly — a place for 
everything and everything in its place. 

Appearance of the Ward 

Beds should be in a straight line, away from 
walls with casters turned in, made up as for 
standard beds (see "Bedmaking") and spaced at 
8-foot center intervals. 

Bedside lockers should be on the right side of 
beds even with head of beds and clear of all un- 
necessary articles. 

Bedside chairs should be in a straight line near 
foot of beds on same side as lockers. 

Overbed tables should be at the foot of the 
beds. 

Window shades should be at uniform height 
and sills cleared of all articles. 

Decks should be clear, shoes and slippers inside 
bedside lockers. 

Waste baskets kept empty ; other furniture ar- 
ranged in orderly fashion. 

Hygiene of the Ward 

Ventilation. — Provide for free circulation of 
air — protect patients from drafts by use of ven- 
tilators or screens. 

Temperature. — Maintain constant and proper 
temperatures during day, 68° (72°-75° during 
bath time), 65° at night. 

Lighting.— Avoid glaring lights in patient's 
eyes; promptly replace burned-out bulbs. 

Odors. — Keep at minimum by prompt disposal 
of excreta, dressings, trash. Use deodorants if 
necessary. 

Noise. — Avoid dropping and banging equip- 
ment and loud talking and laughing ; wear rubber 
heels on shoes. 

Have a systematic routine for cleaning. See 
"Cleaning Schedule." 



NURSING AND NURSING PROCEDURES 



153 



The Patient's Unit on the Ward 

The patient's anil should be :i clean, comfort- 
able place for the patient to live. While he is 
under your care he will spend the greater part of 
his time in his unit He "ill need a comfortable 
bed, a bedside locker for his personal gear, and n 
chair for himself or his visitors. 

Cleaning a Bedside Unit 
Purpose. — To insure a dean, sanitary bed for 

the patient. 

Indicated. — Once a week for all units: upon 
patient's discharge; whenever presence of vermin 

is suspected. 

Equipment. --Basin of warm soapy water; sand 

soap or powder; cleaning cloths; whisk broom; 
newspaper. 

Stripping the Bed 

1. Push bedside locker to back of bed; place 
chair at foot of bed. 

•_'. Remove pillows, strip, and place on chair, 
linen between rungs at foot of bed. 

3. Lift mattress with one hand; pull out linen 
with other hand. Loosen bedding all around bed. 

4. Remove spread, sheets, mattress cover sepa- 
rately, and place between rUUgS. 

.">. Remove blanket and rubber sheet and place 
o\ er back of chair. 

»'.. Take soiled linen (blanket if soiled I to 
laundry hamper. 

7. Remove all articles from the bedside locker. 
Articles to be boiled may be sterilized while the 
uint is being cleaned. See Care of Equipment. 

Cleaning Unit 

1. Place cleaning equipment on to)) of locker. 

2. Spread newspaper on deck under bed. 

3. Swing mattress crosswise to lower half of 

bed. 

•i. With damp brush or damp cloth, brush top 
and nearest side of mattress. Pay particular 
attention to tufts and crevice-. 

5. Raise the headrest of the (bitch bed. "With 
damp cloth wash springs, coils, bed frame; follow 
with dry cloth. 

(>. Lower headrest. Turn mattress clean side 
down onto the upper half of the bed. Brush 
mattress. 




Figure 172. — Cleaning a Bedside Unit. 

7. Place rubber sheet on springs, Wash with 
damp cloth and dry. Turn onto matt re--- clean 
side down and wash other side. 

s. Place pillows on >pnn;_ r -. brush with damp 
brush, and turn onto mattress clean side down; 

do other side. Place blanket over bead of bed. 

'.'. Wash lower springs, coil--, bed frame a- be- 
fore. With damp cloth wash chair; dry well. 

in. Place cleaning equipment on new-paper on 
deck. 

11. Wash locker inside and oiit-ide; dry well. 

1± l'>e sand BOap if UeceSBmrv for enamel 
surface-. 

13. Take equipment to utility room. Scour 
cleaning basin, place in sterilizer, boil 20 minuti 
wash out cleaning 'loth-, ami hang up to dry, 

1 1. Swab deck. I t in room : BWab, wax. and bull 
deck. 

15. Remake bed; square away unit. 

It!. Wherever possible allow unit to air 6 to •_' I 
bouts before remaking bed. 

BED AND BUNK MAKING 

Bed in the hospital. -The hospital bed is 
higher and narrower than the bed in the barracks. 
The purpose is to bring it up to a better working 

level and thus re. luce fatigue and avoid back- 
-train for the personnel caring for the patient. 

The bed with a (Jatch frame is the fundamental 
device for making the patient comfortable. The 
crank-operated Gatch frame permits raising and 
lowering of the head and foot : the newer frame- 
may be adjusted to many different positions and 



154 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



have attachments to support fluid containers, 
orthopedic apparatus, and sidebars. The legs of 
the bed have rubber tired wheels to make them 
movable and are equipped with brakes to make 
them stationary. The mattress in most naval hos- 
pitals is of the inner spring type and should be 
firm, even, and clean. The bedding under the pa- 
tient should be smooth and tight. The upper 
bedding should be loose, of light weight, draped 
evenly, and of sufficient warmth and length to keep 
the patient comfortably warm. 

The bunk aboard ship. — The bunk aboard ship 
is narrower than the hospital bed and may not 
have a Gatch frame. The head or foot of the bunk 
may be raised by inserting a board under the 
mattress. 

BED AND BUNK MAKING PROCEDURE 

(UNOCCUPIED) 
Purposes : 

To provide a clean, warm, sanitary bed or 
bunk to receive a patient. 

To provide a neat, uniform appearance to a 
ward or sick bay. 
Equipment: 

1 mattress cover 

2 sheets 

1 blanket 
1 spread 
1 pillow case 
1 pillow cover 
1 pillow 

When additional protection of the mattress 
is desired, add: 

1 rubber draw sheet 
1 cotton draw sheet 

RECOVERY BED 
Postoperative or Ether Bed 

Purpose: 

To provide a warm, comfortable bed for the 
postoperative patient. 

To protect the mattress. 
Equipment: 

In addition to the equipment listed for the 
unoccupied bed : 

Small rubber sheet 

Cotton sheet 



Paper bag and safety pin 
3 hot water bottles* 
For the bedside locker (176) : 
Curved basin 
Box tissues 

Clock with a second hand 
Pencil and paper 
Sphygmomanometer 
Stethoscope 

Padded tongue depressor 
Bandage 

Procedure : 

1. Make the bottom or foundation bed as di- 
rected in "bed making." 

2. Place the small rubber sheet over the bottom 
sheet at the head of the bed. Fold the cotton sheet 
in quarters ; cover the rubber sheet. Tuck in both 
sheets at sides. 

3. Open top sheet on bed, smooth side down, 
center fold down center of bed, hem even with top 
of mattress. 

4. Open blanket on bed, center fold down center 
of bed, 6 inches from the top of the mattress. 

5. Open spread on bed, center fold down center 
of bed, smooth side up, hem even with top of 
mattress. 

6. Fold spread over blanket, sheet over spread 
at the head of the bed. 

7. Fold sheet over the spread and blanket at foot 
of bed. 

8. Tuck in top bedding along the side away 
from the entrance. 

9. Fold top bedding up onto bed on the side 
nearest the entrance. 

10. Fit pillow into cover and case; place be- 
tween rungs at the head of the bed. 

11. Pin paper bag to side of mattress at the 
head of bed. 

12. Arrange equipment on bedside locker as il- 
lustrated. 

13. Push locker to back of bed. 



♦The practice of placing hot water bottles in a recovery bed 
is gradually falling into disuse. It is recommended that hot- 
water bottles be included only when the bed is prepared for a 
patient in poor physical condition ; for a patient subjected to 
extremes in temperature in traveling to and from the operating 
room ; and when ordered by the doctor or nursing supervisor. 
If hot-water bottles are used, place them in the bed under the 
top cover as illustrated (fig. 177). Be sure to remove hotwater 
bottles before putting patient to bed. 



NURSING AND NURSING PROCEDURES 



155 



BED MAKING 



(A) Mattress cover 

Fold cover bock on itself Place top corner 
of mattress inlo cover, far corner first, 
flap of cover on top of mattress 



TOP 



BOTTOM 




Pull cover down on mattress -working each 
side alternately. 



Fold under excess at foot. Smooth out 
cover, tighten at sides. 



(8) Bottom sheet 

Place center fold of sheet in center of 

bed.norrow hem even with foot, smooth 

side up. Fold excess sheet under mattress 
at head of bed. 




1 



(C) Mitered corner — Pick up hanging sheet 
12 inches from head of bed. 




(2) Tuck lower corner under mattress. 




(3) Hold fold with left hand. 

Bring triangle down over side of bed. 




(4) Tuck sheet under mattress. 



s: 



(D) Top sheet 

Center fold in center of bed, wide hem 
even with top of mattress of head of 
bed, smooth side down. Tuck excess 
under mottress at foot. 




(E) Blanket — Center, in center of bed 6 inches 
from top of mattress Fold excess under 
mottress at foot of bed 




Make mitered corner ot foot of bed. 
Tuck in triangle - do not tuck m sides 




(F) Spread — Center fold in center of bed even 
with top of mottress. Tuck excess under 
mattress at foot Miter corner, allow triangle 
to hang. Fold cuff of top sheet over spreod 
at head of bed. 




Repeat on other side of bed. 

Pull sheet tout before fucking under mottress. 



PILLOWS 




Open pillow cover and fold it bock 
on Itself Gather pillow lengthwise, 
fit corners of pillow into corners 
of pillow cover Grasp pillow 
through pillow cover, pull cover down 
over remainder of pillow. Repeat for 
pillow cose. 




Figure 173. — Bed Making. 



156 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



BUNK MAKING 



ll\ //, 



I Bottom sheet — Center fold center of bunk 
smooth side up. Excess even at top ond 
bottom of mattress. 



2 Tuck far side under mattress. Tuck near side 
under mattress. 





zz\ 



3 Make envelope corners of top ond bottom of mattress. 



5 Make 6" cuff of sheet over mattress. 
Tuck in sheet and blanket farside- 
Tuck in sheet and blanket nearside- 



4 Top sheet — Center fold center of bunk 
smooth side down, wide hem even with 
top of mattress. 

Blanket Center fold center of bunk 6" 

from top of mattress. 



c 



6 Make envelope corner at foot of mattress 



Figure 1 74. — Bunk Making. 



TO PROTECT A MATTRESS OF A BED OR BUNK 



1 . Add rubber draw sheet. Place rubber sheet over 
bottom sheet so that middle third of bed or bunk is 
covered. 





""»".". 









2. Add cotton draw sheet. Fold large sheet in half, 
hem to hem, smooth side out. Completely cover and 
overlap rubber sheet. 





1 

1 

1 

1 

1 

1 

*■-:&■ 

\ 

i 

I 

« 


I 
1 

) 
i 










t 
I 


1 





3. Pull both sheets taut. Tuck under mattress. 



Figure 175. — To Protect Mattress of a Bed or Bunk. 



NURSING AND NURSING PROCEDURES 



157 




Figure 1 76. — The Recovery Bed 



< 



Figure 177. — Hof Water Bottle Placement. 

TO MAKE A BED WITH A PATIENT IN IT 
(OCCUPIED BED) 

Purpose. — To provide clean bedding with least 
exertion to patient. 

Equipment. — Linen a> needed. 
Procedure : 

1. Place chair at foot of bed : push liedside lock- 
er back of bed. 

•_'. Loo-en all bedding at sides and foot of bed. 

■). Remove pillow, strip case, and place on chair. 

4. Remove spread in quarters, fold from top to 
bottom, pick up in center, and place on back of 
chair. 

5. Remove blanket in same manner. 
(!. Turn patient to one side of bed. 

To change bottom sheet, draw sheet: 

1. Roll draw sheet close to patient'- hack. 

2. Fold rubber sheet up over patient. 

3. Roll bottom sheet close to patient's back. 

4. Place clean sheet on bed. center fold in center 
of bed, smooth side up. narrow hem even with fool 
of matt re-.-. 



Figure 178. — Changing the Bottom Sheet. 

•"'. Tuck in excess at head of bed, miter corner, 
and tuck in at side. 

6. Bringdown rubber sheet; straighten. 

7. Fold large sheet in half, hem to hem. so ■ 
side out. 

N - Place on bed, fold toward head of bed, ova 
lapping rubber sheet. 

9. Tuck in rubber and draw -heet- together. 

10. Roll patient over to completed -ide of bed, 
toward you. 

11. Remove wrinkle- from under patient. 

12. Go to other side, fold in soiled -heet-. re 
move, and place in rungs at foot "f bed. 

13. Turn back draw and rubber -heet- over 
patient. 

14. Pull bottom -heet tight and smooth; pro 
vcvt\ as for first side. 

L5. Pull rubber and draw sheets tight; tuck 
under mattress. Do center portion first, then up- 
per and lower end-. 

1G. Bring patient to center of bed. 
Top bedding: 

1. Pla.c tii|> Bheet over patient, smooth side 
down, wide hem even with t<>p of mattress; turn 
down t<> make 10 inch Cliff. 

2. A-k patient t<> hold clean -heet. 

3. Reach under, grasp -oiled -licet, remove, and 
place in rungs at foot of bed. 

j. Place blanket 6 inches from top «>f man 
"Medical Department" Bhould be readable from 
foot of bed. 



8 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



5. Make pleat in sheet and blanket over pa- 
tient's toes, tuck in excess at foot, and miter 
corner. 

6. Place spread smooth side up even with head 
of bed; "Medical Department Insignia" should 
be readable from foot of bed. 

7. Fold spread over blanket; fold sheet over 
spread at head of bed. 

8. Tuck in excess foot, miter corner, and allow 
triangle to hang loosely. 

9. Fit pillow into corners of case; place under 
patient's head, seam toward back, closed end to- 
ward entrance to ward. 

10. Adjust bed Gatch as ordered. 

11. Straighten unit ; leave bedside stand within 
reach of patient. 




Figure 179. — Tee Pleat. 

Modifications : 

1. Top sheet may be used as draw sheet. Change 
top sheet first ; then fold for draw sheet. Proceed 
as above. 

2. Spread may be too short. Make foot of bed ; 
then fold excess, if any, over blanket. 

BUNK ABOARD SHIP (THE OCCUPIED) 

The bunk aboard ship is made in the same man- 
ner, with the following exceptions : 

1. The patient is turned toward the corpsman. 

2. The side of bunk nearest the bulkhead is com- 
pleted first ; the patient is then turned toward the 
bulkhead and the other side of the bunk is com- 
pleted. 

3. The top bedding is made Avith envelope cor- 
ners at the foot of the bunk. 



ADMISSION, TRANSFER, AND DISCHARGE 
OF PATIENT 

Review — Local Station Orders 

ADMISSION 

Ambulatory patient: 

In admission unit: 

Greet patient courteously ; seat him at desk. 
Type out admission card ; follow instructions 
on card. 

Seal patient's gear in presence of the patient ; 
send gear to bag room with hospital ticket. 
Assist doctor with the physical examination. 
Notify ward of patient's admission. 
Send patient to ward with — 

Completed copy of admission card Nav- 
Med 1285. 

History sheets I and II — Forms 504 and 
505. 

Physical examination — Form 506. 

In ward : 

Greet patient courteously, introduce yourself, 
and seat him at desk. 

Take patient's temperature, pulse, and res- 
piration; blood pressure; height and weight. 
(If patient's temperature is 100° or over, put 
him to bed immediately.) 

Find out his chief complaints, other objective 
and subjective symptoms. 

Have patient read the hospital regulations 
and the ward routine. 

Assign patient his bed; provide towels and 
pajamas; introduce him to his neighbors. In- 
struct and supervise patient's tub bath or 
shower. 

Notify doctor of admission. 

Start patient's chart: 
Fill out chart headings. 
Graph temperature, pulse and respiration 

on Form 511. 

Start nursing notes — date, time, manner of 

admission, his chief complaints, and objec- 
tive symptoms. 

Enter patient's name and other necessary in- 
formation in — 



NURSING AND NURSING PROCEDURES 



159 



'ITR book. 

Ward report (Nav Med HF:>). 

Diet list. 

"Ward report hook. 
Insert admission card in ward roster. 
Make out bed tag; place in holder at foot of 
bed. 

Stretcher patient 

Admission unit: 

If patient is able to give information and is 
not seriously ill, follow instructions as for am- 
bulatory patient. 

If patient is seriously ill or unable to give 
information — 

1. Provide necessary emergency measures 
prescribed by the doctor and send patient to 
ward as soon as possible. 

2. Obtain information for admission card 
from person accompanying the patient. 

3. Seal and send patient's gear to bag room 
with hospital ticket. Send receipt for clothes 
with valuables to the disbursing oflicer or offi- 
cer of the day. 

On ward 

Put patient to bod immediately. 

Notify ward doctor and carry out emergency 

measures needed. 

Take patient's temperature, pulse, respira- 
tion, and blood pressure. 

Start chart. 

If patient's condition permits and does not 
interfere with treatment, give bed bath. Note 
rashes, seals. SOreS, reddened areas, or lice. 

Patient in wheel chair or child in arms: 

1. In admission unit : carry out procedure as for 
ambulatory patient. 

•J. On ward: put patient to bed; follow pro- 
cedure as for ambulatory patient; include bed 
bath. 

TRANSFER OF PATIENT 

Admitted from other Ward (AOW) 
Receiving ward: 

1. Have bed ready for the patient. 

2. Receive patient and his records. 



3. Assign patient to his bed; introdu i \m to 

his neighbors. 

4. Have patient read ward routine affecting 
him. 

5. Notify doctor of new admission. 

6. Record "AOW" in Ward Report Book; 
Ward Report : patient'-- chart 

7. Enter patient's name in TPB book, diet list 

8. Place admission card in ward roster, bed tag 
on bed. 

Transferred to other Ward (TOW) 
Transferring ward : 

1. Make out TOW. -lip- — .-end copies to — 

Receiving ward with patient. 

Personnel office. 

Chief of service. 
Officer of the day. 
Post office. 

2. Notify receiving ward. Do not transfer pa- 
tients at mealtime-, visiting hours, or during sick 
call. 

3. Send patient to receiving ward with bis gear, 
chart, and admission card. 

4. Enter as "TOW" in Ward Report Hook, 
Ward Report (Nav Med Hl''.^. 

5. Remove name from TPB book, diet list. 

6. Notify diet kitchen. 

Transferred to another hospital: 
Carry out procedure as for discharge to duty. 

DISCHARGE OF PATIENT 

Discharge to Duty "D" 

Before discharge (may be -Jl to I s ; hours. 
"Station orders"). 

Close out patient's chart: arrange pages iii 

numerical order: attach discharge slip to top 

page. 

Send complete chart to record office. 

Day of discharge: 

Have patient Strip his bed and (lean and 

make up his unit if he is able. 

Check out slip. 

Check those places listed from which the 
patient niii.-t have < learai, 

Tell patient to obtain initials of persons in 
these places and to leave check-out -lip at rec- 
ord office for inclusion in his chart. 



160 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Ward records: 

List patient's name as discharged in Ward 
Report Book and Ward Report. 

Remove patient's name from all other ward 
records. 

Discharge by Death "DD" 

(See "Care of the Dead"): 

Arrange patient's charts in numerical order; 
attach admission card to chart. 

Send complete chart to record office. 

Follow routine for ward records as above, using 
"DD." 

Clean bedside unit. 

CARE OF CLOTHING AND VALUABLES 

Purpose. — To safeguard patient's gear ; to safe- 
guard personnel handling patient's gear; to sim- 
plify procedure for care of patient's clothes. 

Equipment. — Metal seals (Stock No. 42-5- 
2135-200); Personal Effects Tag (NAVMED- 
HF-22) ; pencil or pen. 

Procedure. — On admission. 

In admission unit : 

Seal patient's gear with metal seal in presence 
of patient. Permit only essentials 5 to go to the 
ward. 

Enter number of seal on top and stub portions 
of Personal Effects Tag. Attach top to baggage. 

Give patient stub. 

Send gear to bag room. 

If patient wishes and provides a lock, make a 
note to that effect on reverse side of effects tag. 

In bag room : 

Assign bin or rack to patient's gear. 
Post number of bin or rack on Baggage Record 
Card (NAVMED-HF-25). 

File record card in alphabetical order. 
Store gear in assigned place. 

During Hospital Stay 

1. Care of patient's gear on ward. (See "Sta- 
tion orders.") 



"Essentials are toilet articles, stationery, uniform (1), 
and underwear. All other gear must be sent to bagroom. 
Bags containing articles for bedside use must be small 
enough to fit inside bedside lockers. 



Toilet articles and small bag may be kept in 
bedside locker. 

Uniform may be placed in the ward clothes 
locker. 

The clothes locker must be kept locked except 
when one of the ward personnel is present. 

Deposit and withdrawal system similar to 
that in use in the bag room should be maintained. 

Establishment of regular hours for deposit 
and withdrawal from ward clothes locker is sug- 
gested. 

2. Deposit or withdrawal from bag room dur- 
ing hospital stay. 

Ambulatory patient: 

Patient will break seal and deposit or with- 
draw the desired items in the presence of the 
bag room attendant. 

The bag room attendant will make a note of 
the deposit or withdrawal on the Bagggage 
Record Card. Patient will sign note. 

The bag room attendant will draw a line 
through the broken seal numbers on the record 
card and stub of Personal Effects Tag; attach 
new seals to the gear, and enter new seal num- 
bers on the record card and stub of Personal 
Effects Tag ; give the patient a copy of the new 
seal number (s). 

Bed patient: 

The ward medical officer or nurse will sign a 
memorandum designating a corpsman to with- 
draw or deposit items for a bed patient. 

The bag room attendant will follow same pro- 
cedure as above in resealing gear. 

The memorandum will be attached to the 
Baggage Record Card. 

On Discharge 

1. Patient will report to bag room on day of dis- 
charge with check-out slip. 

2. Bag room attendant will sign check-out slip 
and will staple Personal Effects Tag to Baggage 
Record Card. 

3. Bag room attendant will forward cards to 
record office for inclusion in patient's chart. 

CARE OF VALUABLES 

All patients must be informed of the wisdom of 
depositing their valuables with the disbursing of- 



NURSING AND NURSING PROCEDURES 



161 



liter for safekeeping. Patient must be made to 
understand thai no responsibility is assumed by 
the hospital if be retains bis valuables ;it his bed- 
side. A signed statement by the patient Bhould 
be included in his chart if he insists. Temporary 
storage of valuables in the narcotic locker of the 
ward medicine locker is prohibited. 
Valuables are deposited for safekeeping: 
1. With tin' disbursing officer during the day 
(Ex- 0800-1600). 

•_'. With the officer of the day during the eve- 
ning and nighl i Ex: L6 «00). 

Ambulatory patient: 

1. Send the patient to the disbursing officer or 

officer of the day. 

2. Patient and officer will inventory valuables. 
:'>. The officer will give the patient a signed re- 
ceipt. 



Bed patient : 

I. Valuables will be inventoried by the •• 
medical or nurse officer and the patient. 

'_'. The officer will give the patient a 1 1- 1 1 1 J ■< . i : i ! \ 

receipt for hi- \ aluahle-. 

:;. The officer will take the valuables t<> the dis- 
bursing officer. 

I. The patient will he given tlic disbursing of- 
ficer's receipt and the temporary one will he torn 
up and discarded. 

Incompetent patient: 

1. The ward medical and nur-e officers will in- 
ventory and deposit valuables with the disbursing 
officer. 

•_'. The receipt will he placed in the patient's 

jacket in the personnel office. 



OBSERVATION OF THE PATIENT 

Review — Chapter II, "The Blood and Blood Vascular System" 

"The Respiratory System" 

Chapter III, "Emergency Medical Care" 

Chapter VII, "Drugs Which Act Upon the Circulatory System" 

"Drugs Which Act Upon the Respiratory System" 



Observation of the patient i- the recognition, 

recording and reporting of si<_nis and symptoms in- 
dicating the mental and physical condition of the 
patient. 

The doctor depends upon the corpsman for ac- 
curate recognition, recording and reporting of 
the patient's condition during the day and night 
The COrpsman is with the patient most of the time, 
the doctor only a few moment- each day. [n these 
few moments the doctor must use the COrpsman's 
record and his report in deciding whether the pa- 
tient i> doing well under presenl treatment or 
whether it should he changed or modified. It is 
important to be able to recognize even the >lii_dit- 
est change in the patient because while tin- change 
is >li<rht in itself when combined with other 
changes it may show a definite disease process 
which may indicate further treatment. 

The recording of observations should he done 
a- soon as possible after they have been made. 1 k) 



not wait until the end of the day because by that 
time you may forget a detail which i- important in 
the treatment of your pat ient. Use medical termi- 
nology in your recording hut if you are in doubt 

a- to the correct term, use plain everj day English. 
The reporting of observations Bhould be made 
immediately when prompt treatment i- required. 
When reporting, give complete information: pa- 
tient's name, ward, present diagnosis, T.P.K. 

the symptoms, it- location, duration ami severity, 
and general condition of your patient. 

Purposes. To aid the doctor in making a diag- 
nosis and prescribing treatment for the patient. 
To determine the effects of a prescribed course of 
treatment. To modify the nuisini; care to fit the 
need- of the patient. 

Indicated. < Hbeei \ at ton is essential at all times, 
from the patient's admission until hi- discharge 
and particularly during bath and meal tit 



162 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



while asleep and during treatments and visiting 
hours. 

Signs and symptoms. — Indications of the men- 
tal and physical condition of the patient may be 
classified as objective and subjective symptoms. 

Objective symptoms are those which the observer 
can see — rashes, swelling, inflammation, etc; 
feel — skin eruptions, masses, changes in pulse, etc. ; 
hear — speech, snorting respirations, etc.; smell — 
odors. 

Subjective symptoms are those which only the 
patient can feel or describe, such as pain, tender- 
ness, ache, nausea, etc. 

Additional signs indicating the condition of 
the patient may be determined by the use of in- 
struments, examinations and tests; such as ther- 
mometers, manometers, X-rays, specimens, etc. 

System for observation. — While assisting the 
doctor with a physical examination, note the 
systematic way in which he performs his ob- 
servations. In observing patients note : 

General appearance: 

Is he short? Stout? Thin? Average? 
Does he appear in pain ? Ill ? Well ? 
Does he walk normally ? With a limp ? 

Mental condition : 

Does he appear delirious ? Excited ? Depressed ? 
Restless? Unconscious? Happy? 

Does he refuse to talk or eat ? Does he shout or 
sing? 

Does he appear sullen? Aggressive? Coopera- 
tive? 

Does he sleep well, poorly ? Is he restless in his 
sleep? Does he moan, groan, or cry out in his 
sleep ? 

Position : 

Does he stay in one position? On his side or 
his back? Does he draw his legs up on his ab- 
domen ? 

Does he have difficulty breathing when he lies 
down? 

Is his neck stiff? Arched backward? 

Is he able to move about in bed ? 

Skin: 

Is the skin hot ? Cold? Dry? Moist? 
Is the skin flushed ? Pale ? Cyanotic ? 
Are there any scars ? Wounds ? Rashes ? 



Does the skin appear shiny? Stretched? Is 
there edema present? 

Is a pit made when the fingers are pressed into 
it? 

Are there any lice ? Nits ? 

Eyes: 

Are the eyelids swollen, bruised or discolored? 

Are the whites of the eyes clear ? Dull ? Yel- 
low? Bloodshot? 

Are the pupils contracted? Dilated? Equal in 
size? 

Does he complain of pain? Burning? Too 
much light ? 

Ears: 

Do the ears appear normal ? 

Does he seem to hear well ? 

Does he complain of buzzing or ringing in his 
ears? 

Does he have any discharge from his ears? 
What kind is it? 

Mouth : 

Does his tongue appear dry? Moist? Clean? 
Coated? Cracked? Red? Spotted? 

Does he complain of an unpleasant taste? Is 
there an odor to his breath ? 

Are his teeth in good repair ? Clean ? Does he 
have removable bridges? Dentures? 

Does he have any sores in his mouth ? Does he 
complain of any soreness? 

Nose: 

Does his nose appear to be straight ? 
Does he appear to have difficulty breathing 
through his nose? 

Is there any nasal discharge present? 

Chest: 

Are there rattling, snorting or wheezing sounds 
when he breathes? 

Does he have pain or difficulty breathing? 

Is he coughing? Is the cough productive? 
Dry? Hacking? Persistent? 

Is sputum expectorated ? Is it white ? Yellow 
or rusty? Thick or thin? Large or small 
amount ? 

Abdomen, bowels, and bladder: 

Is the abdomen distended? Is the distention 
above or below the umbilicus or over entire ab- 
domen ? 



NURSING AND NURSING PROCEDURES 



163 



Is there a belching of £_ r a- 1 

Is he nauseated? 

Is he vomiting! Is there pain and nausea 
associated with it I How often does he vomit I 
What does the vomitus look like! Color? 
Amount? Odor? Contents? 

Has he had a bowel movement 1 Whenl Is 

he constipated? Does he have diarrhea? Is he 
incontinent? What is the color, consistency, 
amount and odor of the faces! Is there hlood or 
pus! Are there worms ? 

Does he void sufficiently! Does he void fre- 
quently in small amounts? What is the color, 
odor, and amount of the urine? Is there hlood or 
sediment in the urine? Does he have difficulty 
passing urine! Is he incontinent? 

Pain: 

Where is the pain or ache? How severe is it? 
Is it sharp, dull, aching, knife-like! Is it constant, 
intermittent I How long has he had it i 

Does he assume a special position to relieve the 
pain? 

Has he had a medication for the pain? Has the 
medication relieved him! 

Wounds: 

What is the condition of the wound? I- it 
clean? Is it reddened ? Swollen? Painful? 

[a there a discharge presenl i What is its color, 
odor, and consistency! Is it bloody! 

Assisting With a Physical Examination 

Purpose. — To aid the doctor in making a diag- 
nosis; to aid the corpsman in planning necessary 
nursing care. 

Equipment. — Tray with : 

Diagnostic set (ophthalmoscope, otoscope). 

Tongue depressors. 

Flashlight. 

Stethoscope. 

Sphygmomanometer. 

Tape measure. 

Skin pencil. 

Percussion hammer. 

Paper bag for used depressors. 

Curved basin for specula. 

Safety pins. 

Rubber gloves or finger cot. 

Paper towel. 



Procedure of examination: 

Preparation of patient ■ and equipment : 

1. Place patient in a warm, well-lighted room 

or screened area. 

2. Tell patient what is to he done and how he 
may help. 

.'!. Undress and COVer patient with sheet. 

4. Take and record height, weight (place paper 
towel on scale i. 

5. Place patient in horizontal position. 

6. Have all equipment at hand. 

Technique of examination: 

1. Doctor will usually examine patient's head 
first and then proceed to chest, abdomen, extremi- 
ties and genitalia. As the examination prOj 
expose each part of the hody. 

•2. Place patient in proper position for exam- 
ination desired i fig. I s "). 

After examination: 

1. Make patient comfortahle in IkhI. 

2. Strip, clean, reset tray. 

Cardinal Symptoms 

Temperature, pulse, respiration (TPR) and 
blood pressure I BP I are called the cardinal symp- 
tom.- because they give important and vital indica- 
tions of the condition of the patient. The measure- 
ment of these symptoms and their relationship to 
each other aid the doctor in making a diagno 

and prescribing treatment and may help the COrpS- 
man determine the amount and kind of nursing 
care necessary for his patient. 

TEMPERATURE 

Temperature is the degree of heat in the hody. 
It is the balance between heat produced and heat 

lost by the hody. When the balance i- disturbed, 
deviations of bodj tempera! lire result. Deviatii 
above the normal range are called elevations <>r 
fever: those below normal range are called sub- 
normal. 

Normal temperature. The normal range is 
97° t<» '•''.' I". i month i : 98 to 100 I", (rectum) ; 
96° to'.'- I", i axilla). The normal temp 
i- usually :it it- lowest point in the early n 
and at it- highest in the late afternoon. 



'When female patient i- ImMhc examined, a female 
(corpc none officer) mtud be present. 



164 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




SIMS — Used for rectol, voginol and perineal 
examinations ond treatments 



DORSAL RECUMBENT — Used for examination of 
external genitalia , urethral, vaginal ond rectol 
treatments 




DORSAL LITHOTOMY — Used for examination of 
externol genitalia-, urethral , vaginal and rectol 
treatments 



SHOCK or TRENDELENBERG — Used in treatment of 
shock-, pelvic ond abdominal surgery. Blocks also 
used for' orthopedic potients in traction 




LUMBAR PUNCTURE — Used for lumbar puncture. 
Important- Hips and shoulders must be in the 
some vertical plane 



MODIFIED JACK KNIFE — Used for rectol examination 
ond treatment. Legs may hang down straight 




POSTURAL DRAINAGE - GATCH BED — Used to POSTURAL DRAINAGE- STOOL METHOD — Used to 

promote droinoge from respirotory tract. Patient promote drainage from respiratory tract 

is placed over knee break of bed 



Figure 180. — Positions for Examinations and Treatments. 



NURSING AND NURSING PROCEDURES 



165 



104 
103 
102 

101 
100 

• 9 
96.6 

96 

• 7 



iHMpll^lhS^iM^iBp^B 



CONSTANT 



REMITTENT 
Figure 181. — Types of Fever. 



INTERMITTENT-SPIKING 



Fever. — Fever may begin suddenly <>r gradu- 
ally mid its course may I »»» constant, remittenl 
or intermittent. 

A constant fever is one in which the tempera- 
ture remains elevated at about the same level dur- 
ing a period of 2 1 hours or longer. 

A remittenl fever i- Dm- in which the tempera- 
ture rises and falls in a moderate range but dot- 
not approach normal. 

Aii intermittent fever is one in which the tem- 
perature rises and falls in a great range, approach- 
ing normal or below in a 24 hour period. 
Fever may Bubside in two ways: 

l. Suddenly by (CRISIS) in which there is an 
abrupt drop to normal with dramatic improve- 
ment of the pat ient. 

■_>. Gradually by (LYSIS) in which the return 
to normal extends over a period of days or weeks. 

Subnormal. — Deviations below normal range. 
I )ue to shivering mechanism of the body, this type 
of temperature is not often encountered except in 
certain periods of extreme illness when the sub- 
normal temperature would indicate hotly resist- 
ance is being overwhelmed. It i> also found in 
many chronically ill. Starving, cachectic or ema- 
ciated pat ients. 

Taking the temperature. — Body temperature 
is measured by the clinical thermometer. The 
thermometer is scaled in the Fahrenheit system 
and calibrated in -' 10 o . 

Routes of measurement are: 

1. I'>y mouth which is the easiest and most often 
used route. The thermometer is left in place 3 
minutes. 

2. By rectum, which is the most accurate, and is 
used Eor children, delirious or unconscious patients, 

•Jl 1 siiO" — 53 12 



"I'Tn'T"' 
St IPO 






I""! 

■■9 



_aa_£ ri icjo ,' a & a. 



Figure 182. — Types of Thermometers. 

and patient- who are mouth breathers, who cough 

frequently, or who have had mouth BUTgery. The 

thermometer is held in place 5 minutes, 
:;. By axilla which i> leasl accurate and used 

only when mouth ami rectal route- cannot he used. 
The thermometer is held in place LO minute-. 

Shaking down the thermometer 

1 . Stand in clear space aw ay from bedside table. 




Figure 183. — Shaking Down the Thermometer. 



166 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



2. Hold thermometer firmly at top between 
thumb and first two fingers. 

3. Shake with loose wrist movement as though 
shaking water off' the hand. 

4. Shake thermometer down to 95° F. 

Reading the thermometer 



0- 




98 



t 
98.6 



99 



Figure 1 84. — Reading Ihe Thermometer. 



1. Stand in a good light. 

2. Hold thermometer at the stem end, ridge side 
toward you. 

3. Read the scale to include the degree and the 
nearest % of a degree. 



^MvK 



Taking the pulse.— The pulse may be taken 
wherever an artery lies near the surface of the 
body or over a bone. The most frequently used 
site is the radial artery on the thumb side of the 
wrist. Other arteries which may be used are the 
temporal (side of the head in front of the ear) ; 
the carotid (front side of neck, may often be seen 
beating) ; dorsalis pedis (the top of the foot) . In 
the measurement of pulse, the pulse rate (number 
of beats per minute), the force (strength or weak- 
ness of beat), the rhythm (regular or irregular 
space between beats) , and the volume (full or soft) 
are noted. 

The pulse is usually taken at the same time the 
temperature is taken and whenever the patient 
shows a change in condition, postoperatively 
while recovering from anesthesia, when getting 



NORMAL 



THREADY INTERMITTENT 

Figure 185. — Variations of Pulse. 



MISSED BEAT 



PULSE 



Pulse is the alternate contraction and dilation 
of the arteries due to the pumping of the blood by 
the heart. Changes in the character of the pulse 
may be due to any factor which interferes with the 
function of the heart, the volume of the blood, 
and the elasticity of the blood vessels. Therefore, 
the measurement of the pulse is a valuable means 
of learning the condition of the heart, blood ves- 
sels, and general condition of the patient. 

Normal pulse. — The pulse rate even in good 
health varies with the individual. The rate is 
faster in infants and young children, slower in 
aged persons, faster in women than in men, and 
is affected by exercise, fatigue, and emotions. 
The normal range for adult women is 72 to 80 ; for 
adult men 62 to 72 pulsations per minute. The 
pulse rate usually increases 10 beats for each de- 
gree rise in temperature. The normal pulse 
should feel firm, smooth, straight, and elastic un- 
der the finger tips and should be regular in rate 
and rhythm. 



out of bed for the first time, and when receiving 
medications affecting the pulse. 

Variations of pulse 

Normal: Regular rate, rhythm, force, and 
volume. 

Missed beat: Regularly irregular in rhythm 
and rate ; may be irregular in force and volume. 

Intermittent: Irregular rhythm and rate; may 
be irregular in force and volume. 

Thready : Rapid, running, difficult to count or 
to determine quality. 

PROCEDURE FOR TAKING AN APICAL- 
RADIAL PULSE 

Purpose. — To compare the pulse rate of the 
heart (apex) and radial artery. 

Equipment. — Stethoscope; watch (with second 
hand) ; alcohol sponge. 

Procedure 

Preparation of patient. 

Patient lying quietly in bed. 
Open pa jama coat; expose chest. 



NURSING AND NURSING PROCEDURES 



167 



First corpsman • on left aide of bed. 

Place stethoscope in ears, earpieces Facing 
forward. 

Locate apical pulse (slightly below and t<> 
the right of t!n' left nipple) . 

Listen to the sounds for a few minutes, until 
the rate and rhyl Inn are familiar. The sounds 
will be somewhat like lii!>-dnl>, lub-dub; each 
lub-dnl) is one beat. 




Figure 186. — Taking an Apical — Radial Pulse. 

Second corpsman on right side of bed. 
Locate radial pulse. 

Hold watch so that it can be seen by both 
corpsmen. 
At signal of the one taking the apical pulse, 
both corpsmen count pulses for 1 minute. Re- 
check. 

Replace pajama coat ; leave patient comfortable. 
Wipe earpieces of stethoscope with alcohol 
sponge. 

Record on pat ient's chart in observation column 
of nursing notes. Use plotting chart if pulsus are 

to he recorded graphically. 

RESPIRATION 

Respiration is the act of breathing in (in- 
haling) and breathing out (exhaling) air (oxy- 
gen) by the lungs. Oxygen is needed 1>\ the body; 

the act of respiration supplies this need. 

7 Two oorpamen are neceeaarj because tbeae pnlaei must be takes 
at the game time to compare the rates. 



Normal respiration*— The normal respiration 
i regular in rate, rhythm, and depth ami is per- 
formed without pain, -train, or difficulty. The 

normal rate i- rapid in infants and m young chil- 
dren, slow iii aged persons; ranges from 16 _'i per 

minute in healthy adults ami i- affected !'■ 

Bex, exercise, Bleep, and emotional disturbances. 
The respiration usually increases 1 to -i in rate 

with every lo heat rise in pulse and each degree 

rise in temperature. Respirations may be con- 
trolled to some extent by the patient and should l><- 
counted without bis knowledge if possible. Res 
pirations ma\ he counted by watching the rise and 
fall of the chest, listening to patient*- breathing, 
or feeling thechesl move up and down. 

Variations of respirations: 

Dyspnea — painful, difficult breathing. 
Air-hunger short, g asping breath- followed by 

a few normal breaths. 
Stertorous — loud, snorting breathing. 
Edematous — moist Bounds as if air is passing 

through water. 

Taking Pulse and Respiration 

1. Have patient lie or sit down. Place his arm 
and hand in a relaxed position, thumb up. sup- 
ported on a chair arm. table, bed. or placed a 

his chest. 

2. Locate pulse by placing the tii-t :'. li> 
(not your thumb) on the thumb -ide of patient's 
wrist. 

3. Count pulse rate for 30 seconds, multiply by 
2, and record a- number of beats per minute. 
Check again, noting the quality (force, rhythm. 
volume). If any deviation is noted, take pulse 
for full minute. 

4. With fingers still on wrist, count respirat 

for 80 seconds; multiply by •_' and record as num- 
ber of respirations per minute. If any deviations 
are noted count respirations for full minute. 

Procedure for Taking Temperature (Oral), 
Pulse, and Respiration 

Purpose. — To determine the degree of tempera- 
ture, the rate and characteristics of the pulse, and 

ration of the patient or group of patients. 



168 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 187. — Thermometer Tray. 

Equipment 8 

Tray with — 

2 covered containers of alcohol 70 percent. 

6 thermometers — 3 in each container of al- 
cohol. 

1 container of water. 

1 container of soap solution. 

1 container of cotton squares. 

1 sputum cup for waste cotton. 

1 clock or watch with a second hand. 

1 TPR book. 

1 pen or pencil. 




Figure 1 89. — Taking the Temperature, Pulse and Respiration. 



Precautions 

1. Have the patients lying quietly in beds or 
sitting down in chairs. 

2. Wait for 30 minutes before taking the tem- 
perature of a patient who has had a hot or cold 
drink or has been smoking. 

3. Be sure the thermometer is down to 95° F. 
before placing it in the patient's mouth. 

4. Be sure the thermometer is under the pa- 
tient's tongue. 

Procedure 

1. Remove a thermometer from the first con- 
tainer of alcohol. 

2. With a cotton square and in a rotary motion, 
wipe the thermometer from bulb to stem. 9 Shake 
down thermometer to 95° F. 

3. Place thermometer under the first patient's 
tongue ; caution him to keep his lips closed. 

4. Distribute the other thermometers to the 
second and third patients in the same manner. 

5. Take the pulse and respirations of the third 
patient. Record in the book. 

6. Repeat step 5 for the second and first patient. 

7. Remove the thermometer from the first pa- 
tient's mouth. 

8. Moisten cotton square with soap solution; 
wipe the thermometer from stem to bulb in a 
rotary motion. 

9. Moisten a cotton square with water; wipe 
the thermometer from stem to bulb in a rotary 
motion. 

10. Read the thermometer and record reading 
in the book. 

11. Place the thermometer in the original alco- 
hol container. 

12. Repeat steps 8 through 11 for the second 
and third patients. 

13. Remove the thermometers from the second 
alcohol container. 

14. Repeat steps 2 through 12 for the next three 
patients. 

15. Continue alternate use of the thermometer 
containers until all patients' temperatures have 
been taken. 



8 C. Richard Smith, "Alcohol As a Disinfectant Against the 
Tubercle Bacillus" (Public Health Reports 62: 36, September 5, 
1947) 1285-1295. Repr. BUMED Newsletter 10:8. 



9 Tests at NN.MC showed the important step in cleaning a ther- 
mometer was the mechanical action of rotary motion when wiping. 



NURSING AND NURSING PROCEDURES 



169 



ic>. Record temperature, pulse, :m<l respiration 
graphically on each patient's chart. Describe 
abnormal characteristics of pulse and respiration 
in observation column of the nursing notes. 

Care of Equipment 
After each use 

1. Remove waste. 

•_\ Reset tray. 

:;. Stow in proper plat 

Daily 

1. Filter alcohol. 

•_'. Boil containers and tray for 1" minutes. 

•">. Wash thermometers in cool soap} water; 
rinse and dry. 

I. Refill ami reset tray. 

Norn.- Where snffldenl thermometers arc available for 
ail patients, follow tbe procedure a- outlined in "Ther- 
mometer technique in a communicable disease ward." 

Procedure For Taking a Rectal Tempera- 
ture 
Equipment 
Tray with : 

Rectal thermometer in disinfectant solution. 

( !ontainer soap solution. 

Container cool water. 

( Container cotton squares. 

Sputum cup for waste. 

Lubricant on t issue. 

Precautions 

l. Wait for -">n minutes before taking the tem- 
perature after the patient has had an enema. 

•2. Use only a stnl) bull) thermometer expressly 
made for rectal use. 

:'». Be sure to lubricate the thermometer. 
I. Hold the thermometer in place. 

Procedure 

Wash Your Hand.-! 

1. With cotton square wipe down thermometer. 

•_'. Shake down and lubricate thermometer. 

3. Turn patient on his side. 

4. Insert thermometer about 1 j ■_, indie- into rec- 
tum in an upward and forward direction. 

•'). Hold thermometer in place •"> minutes. 
(>. Remove thermometer. 
7. .Moist (>n cotton with soap solution, w ipe down 
thermometer; repeat, using water. 



B. Read thermometer; place in disinfectant. 

'.'. 'lake pulse and rc-pirat ion. 

in. Record I PR in book. 

ll. Record *d!" above temperature in book ami 

on <liart. 

For an Infant 

1. Steps l and •_' above. 

2. Unpin diaper. 

■".. Lift infant"- le:_ r - with one hand, holding ai 
the ankle-. 

I. In-eii thermometer '_• to •''•, inches into rec 
turn. Hold in place 5 minuti 

5. Proceed a- in steps 6 through 1 1 above. 

6. Repin diaper. 




figure 190. — Method of Holding Infant's Legs. 

Procedure for Taking an Axillary Tempera- 
ture 
Equipment 

Same a- for an oral temperature plus hand 
towel. 

Precautions 

1. I'.e -lire the axilla i- dry. 

•_'. Be sure the arm i- pressed closely to the 

bod\ . 



170 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Procedure 

1. Wipe axilla dry. 

2. Place the thermometer in axilla. Have pa- 
tient grasp his opposite shoulder and press his 
arm against his body. 

3. Leave in place 10 minutes. 

4. Proceed as in oral temperature instructions. 

5. Record "A" above temperature in book and 
on chart. 




Figure 191. — Taking an Axillary Temperature. 

BLOOD PRESSURE 

Blood pressure is the force that the blood ex- 
erts against the walls of the vessels through which 
it flows. The blood pressure is commonly meant 
to be the pressure in the arteries. The pressure 
in the arteries varies with the contraction (work 
period) and the relaxation (rest period) of the 
heart. When the heart contracts the blood in the 
arteries is at its greatest pressure. This is called 
the systolic pressure. When the heart relaxes the 
blood in the arteries is at its lowest pressure. This 
is called the diastolic pressure. The difference be- 
tween both pressures is called the pulse pressure. 

Normal blood pressure. — A systolic pressure 
of 110 to 136 millimeters of mercury and a dia- 
stolic pressure of 60 to 90 mm. may be considered 
as being within the normal range. The pulse 
pressure is usually about one half the diastolic 
pressure. 

Measurement. — The blood pressure is measured 
in the brachial artery by means of a sphygmo- 




Figure 192. — Diagram of Blood-Pressure Apparatus. 

manometer and a stethoscope. The cuff of the 
manometer (containing a rubber bladder) is 
wound about the upper arm and is inflated with 
air until the air pressure inside the cuff equals 
the pressure of the blood inside the artery and the 
walls of the artery collapse. The air in the cuff 
is then slowly released until the first regular 
sound is heard ; this is the systolic pressure. The 
air is further released until a change in the char- 
acter of the sound is heard ; this is the diastolic 
pressure. 

Procedure for Taking a Blood Pressure 
Reading 

Purposes 

To determine the systolic and diastolic blood 
pressure in the brachial artery. 
To determine the pulse pressure. 

Equipment 

Stethoscope. 
Sphygmomanometer. 
Alcohol sponges. 

Precautions 

1. Explain procedure to the patient to lessen 
his fears or appz'ehension. 

2. Patient must be at rest, lying down in bed 
or sitting quietly in a chair with the arm to be 
used well supported. 



NURSING AND NURSING PROCEDURES 



171 



8. Be sure the cuff of the apparatus is completely 
deflated and the indicator registers zero before 
start ing the procedure. 

4. Wipe the bell and earpieces of the stetho- 
scope with an alcohol sponge before starting the 
procedure, 

.'». When repeated readings are ordered, the 
same arm should be u>^(\ and the same person 
should carry out the procedure. 

Procedure 

1. Push patient's sleeve well above his elbow; if 
sleeve is tight, remove it. 

2. Starting with the wide portion of the cuff 
( A) wrap it snugly and smoothly around t he arm 

above the elbow. Tuck narrow end (B) under the 

previous turn (fig. 192). 

.">. (dip indicator < (') on the cuff i aneroid type) 
or place apparatus on a level surface (mercury 
type). 

I. With the fingers, locate the brachial pulse at 
the bend of the elhow. 

.">. Place the stethoscope in the ears, earpieces 
facing forward. 

6. Place the hell of the stethoscope oxer the spot 
where the brachial pulse was felt. 

7. Tighten thumb screw of the valve (D). 

5. Holding the stethoscope in place, inflate cull 
with the hull) (E) until the indicator reads 200 
mm. or to 20 mm. above where the sounds are no 
longer heard. 

!). Loosen the thumb screw of the valve to allow 
the air to escape slowly. 




Figure 193. — Taking a Blood Pressure Reading. 



I". Listen for the Bounds, watch i he 
and note the number <>n the indicator when- the 
first distinct rhythmic sound is heard. I s the 
Systolic pressure. 

II. ( 'out i nuc releasing air from the cull and note 
the number on the indicator at which the -<>iind 

changes t<> a dull muffled beat. This is the dias- 
tolic pressure. 
L2. < )pen the valve completely, releasing all the 

air in the cull. 

L3. Repeal stops •"• through 12 to recheck. 

II. Remove the cuff from the arm; roll cuff 
from the narrow to wide portion and place it in its 
case. Be sure the tubing is not pinched or kinked. 

L5. Wipe earpieces and bell of stethoscope with 

an alcohol Bponge. 

III. Record in tin- nursing note- the -y-tolir 

pressure over the diastolic pressure (Ex: H. P. 

120 80 ) or graph a- directed. 

THE PATIENT'S CHART 

Review — Appendix, Some Symptoms To 
Be Observed and Terms to Use in 
Recording Them 

Purposes. — To provide a clear and concise rec- 
ord of the patient's condition and progress; to 
record effects and results of treatment the patient 
is receiving; to aid the doctor in making a diag- 
nosis and in prescribing treatment: to help the 
corpsman adapt his nursing care to lit the needs 
of the patient: to provide records for study, re- 
search, and stat isticS. 

Indicated. — For all pat ienta 

Order of Patient's Chart 

1. Temperature, pul.-c. respiration .-heet form 

511. 

2. Doctor's older .-heel — form 608. 

:'>. Doctor's progress sheet -form 609. 
I. Nursing notes form .'do. 

5. Laboratory report form .Ml (reports 514 

S-m are stapled to this sheet). 

(;. History, pari I — form 504; parts II and HI, 
form 505. 

7. Physical examination — form 506. 

8. All other form- required for patient. 

!». When additional sheet- are required, place 
them in front of the completed -heet- 



172 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



10. Arrange charts in numerical order when 
sending to record office for change of diagnosis 
or upon patient's discharge. 

The corpsman should be familiar with all clini- 
cal record forms but is responsible for maintain- 
ing accurate, complete, and up-to-date tempera- 
ture, pulse and respiration sheets ; nursing notes ; 
intake and output records ; plotting charts where 
used; and for stapling and/or inserting other 
forms and reports on the patient's chart. 

ABCDEFGHIJKLMNOPQRSTUVWXYZ 
abcdefghijklmnopqrstuvwxyz 

One letter space between words 
Figure 194. — Guide for Printing. 

NURSING NOTES (FORM 510) 

General instructions 

1. All entries shall be printed in black ink. 
(Entire 24 hour period) . 

2. Navy date and time shall be used: (10 Jan 
1952,0200). 

a. Date shall appear only at midnight and at 
the beginning of each new page. 

b. Hour shall accompany each new entry. 

3. Entries shall be signed in the observation 
column with the full signature of the person mak- 
ing them. The signature may be placed at the 
end of the day's entries if the same person has 
made all of them. 

4. When an error is made, draw a straight line 
through error. Write "Error." If for any reason 
a page must be copied, it must be marked "Copy" 
and the original must be retained on the chart. 
No erasures are permitted. 

5. Medication and treatment column. 

a. Diets and nourishments shall be included 
in this column. 

b. Liquid measures shall be in metric system. 

c. Name of medication, dosage, and manner 
of administration if other than by mouth, shall 
be recorded after it has been given. 

d. Name of treatment, amount of solution if 
used, and the duration of treatment if for pre- 
scribed time shall be recorded after it has been 
given. 

e. For diets, medications, and treatments that 
are repeated at stated intervals in a 24-hour 



period, chart the first time of the day they are 
given and the hours at which they are to be 
repeated. Draw a line through the first hour 
and place your initials above the hour. Draw 
a line through and initial the correct hour each 
time the diet, medication, or treatment is re- 
peated. When a diet, medication, or treatment 
is not given for any reason, circle the hour, initial 
it, and record the reason for the omission in the 
observation column at the appropriate hour. 
When a medication or treatment is discontinued, 
make an X over the remaining hours listed. 

/. Treatments being given continuously shall 
be charted each morning and evening. 
6. Observations column. 

The recording of complaints and symptoms of 
the patient is an accepted responsibility of ward 
personnel. It is an account of the patient's con- 
dition and progress. 

The record must be accurate, concise, clear, com- 
plete, and in language which is understood by all 



CLINICAL RECORD 



NURSING NOTES 



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Figure 195. — Sample Nursing Notes. 



NURSING AND NURSING PROCEDURES 



173 



who have access to the chart The terms nsed 
should be those of standard usage and should not 
be abbreviations <>r contractions unless on the ac- 
cepted lists. 

Tlic lettering should be neat and uniform in 
height and in spacing. There should be a one 
letter space bet ween \\ ords. 
The report should be pleasing to the eye* 
The report must be factual and truthful with- 
out interpretation. II' interpretation of a pa- 
tient's subjective symptoms is necessary, qualify 
statement by "appear-" or "seems." Wherever 

possible, record patient'.- complaints in his exact 
words. 

Bach entry need not he a complete sentence hut 
should contain sufficient words to convey a com- 
plete thought. 

Bach new thought will he stalled on a new line. 

On admission of patient include — 

1. Manner of admission. 

•J. Chief complaint of the patient. 

:'». Observation of the patient (objective and 
subject i\ e symptoms). 

I. Abnormal characteristics of the pulse and 
respiration musl he fully described. Recording 
of TPR is not necessary; it is recorded on form 
•Ml. 

5. Notification of doctor. 

6. Nursing measures given. 

Daily entries will include — 

1. All observal ions made. 

Object ive ami subjective .-ymptoms. 
EiFects of medications and treatments. 
Changes in patient's condition. 

2. All supportive nursing care given; hygienic, 
comfort, and diversional measures. 

3. Use of restraints, siderails, ami reasons why 
applied. 

I Notification of doctor. 

.">. 1 doctor's vi-its other than routine sick call. 
('.. Trips to other departments, clinics. 

7. Working order of apparatus in use, such a> 

Wangensteen, tidal drainage, etc. 
B Specimen sent to laboratory. 

!>. Any unusual happenings (fell out of bed, 

etc.). 

10. Administration of last rites. 



Temperature — Pulse-Respiration, Fahrenheit 

(Form 511) 
General instructions 

l I fse black ink- for all entries. 

•_'. After patient'- name at the bottom "f i 

print his serial number, rank or rate, branch of 
Ben ice, or civilian statue. 

8 Form 511 is usable for one week. The graph 
i- divided into seven major columns- -one for each 

day. Bach daily column i- -uhdivided into two 
part- — a. in. and p. in. Each subdivision i- fui 

tlier divided by two vertical dotted hue-. Note 

that the dot- in the line- divide the horizontal 
-pace- into live even divisions. 

I. For every four hour ami twice-a-da] rend 

ingS place the recordings within the dotted line-. 
."'. For four-time- a day readings, place the 

recordings on the dotted lii ■ 

6. Use t he .-a i ne symbol, a dot the -i/e of a pin- 
head, for indicating the temperature, pul-e. or 

respiration. 

7. The blank space beneath the graph and above 

the patient's name may he used a- needed. Some 
uses of the space may he : 

a. For twenty-four hour totals of intake and 
output. 

h. Special medical ion- or t reatmei 

Example of Form 51 1 in Use 

Fill in spaces as shown on sample sheet. In 
space — 

Print hospital day. 

© Print postoperat ive day. 

© Print month and year. 

© Print day and month. 

© Print hour- readings are made. 

©-©-©-Record temperature, pul-e. and I 
piration by dot- corresponding vertically to 
hour, horizontally t<> scale Conned dot with 
previous recording by a -olid line. 

© Full name, serial number, rank or rate. 

branch of service, or civilian status -Obtain 

this information from admission card. 

(jo) Hospital register number— Obtain this 
number from admission card. 

@ Name or number of waul. 

@ Name of hospital or medical facility. 

Note.— Where repeated blood pressure recording! are 
required, tbe osi r -ted 



174 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



ruillllklll I B r B 



CLINICAL RECORD 



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Figure 196. — Example of Form 511 in Use. 






CLINICAL RECORD 



CLINICAL RECORD 



WEEKLY WEl&HT CHART 



BLOOD PRESSURE 



JAN.I9S2 
LBS Z 9 1(2330 



200 zr 










175 










150 










125 i . - - - 


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weight a;" 


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Plotting Chart (Form 512) 

This form may be used for additional graphic 
representation of data. 
Suggestions for Use: 

Blood pressure recording. 

Comparison of intake and output. 

Weight chart. 

Drainage chart. 

General Rules for Constructing Graphs 

1. Purpose of chart must be known; print pur- 
pose in upper left-hand space provided. 

2. A graph should always read from left to 
right. 

3. Measurement should be calibrated along ver- 
tical portion of graph. 

a. Scale should be at a definite and uniform 
rate of progression. Ex. : — 10 — 20 — 30, etc. 

b. Scale should be labeled at top to show units 
of measure. Ex. : cc. — lbs. — mm. — gin., etc. 



200 i 




















175 




















150 
















.._ -,*w 




125 ^ J * 




















100 _i_ ? » 




















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CLINICAL RECORD PLOTTING CHART 


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Figure 197. — Sample Plotting Charts. 



NURSING AND NURSING PROCEDURES 



175 



4. Passage of time should be noted ;i!<>mr hori- 
zontal portion of graph. Example: Dates 
ami or hours measurements are made. 



Meaning of symboh osed in iould be 

show ii in a Ucv to the side of the graph. 

8. When lines are osed in graphing they Bhould 
be labeled t" the 1 « * r t of their starting points. 



PROVIDING FOR THE PATIENT'S COMFORT 

Review — Chapter II, "The Skeletal System" 

"The Muscles" 

"The Digestive System" 

"The Excretory System" 

Chapter V, "Food in Health and Disease" 

Chapter VI, "Personal Hygiene for Individual Protection Against Disease" 



Comforj '" is the enjoyment of physical and 
mental well-being. This applies to the corpsman 
as well as to the patient. 

One of the essentials of physical comfort is 
good posture. Good posture is the position of the 
body in correct alignment when standing, sitting. 
lying down, or in any phase of activity. The co- 
ordinated use of the body part- tn produce mot ion 
and maintain equilibrium is termed "Body me- 
chanics." The use of good posture and proper 
body mechanics by the corpsman when taking care 
of his patient will serve to: 

1. Conserve the energy of the corpsman. 

2. Promote the efficient use of muscles by the 
corpsman. 

•".. Avoid backstrain and fatigue of the corps- 
man. 

t. Teach his pat ient, by example, the importance 
of good posture. 

The maintenance of good postural position of 
the patient while in bed will serve to: 

1. Promote the proper functioning of the body 

systems. 

2. Promote a feeling of well-being. 

3. Avoid fatigue and prevent deformities. 

Providing for the mental comfort of the patient 
include- : 

1. Adequate explanation of what is to be done. 

2. Anticipating his wants. 

3. Listening to his problems and referring him 
to the proper person or department when neces- 
sary. 

These are but a few of the ways of providing 
for the mental comfort of the patient. The corps- 

*8ee p. 149, "PnipoMi of nursing." 



man. by experience, will learn t" recognize the 
genera] reactions of individuals, what causes peo- 
ple to behave the way they do and to u-e these ex- 
periences in providing more complete care for his 

subsequent patient-. 

Principles of Moving and Lifting 

The following principle- may be applied to any 

moving or lifting activity a- well a- to moving 

and lift ing the pat ient. 

1. Place your body in correct alignment before 
starting the activity. 

•2. Place your feet far enough apart to provide 

an adequate base of support and to maintain 
balance. 

3. Hold the object to be carried a- close to the 
body a- possible SO that the center- of gravity of 
both will be close together. 

l. Use the large muscle groups to lessen -train 
and fatigue. 

5. Stoop to working level, keeping the back 
straight. 

6. Slide, rather than lift a patient or object 
whenever possible. 

7. Give adequate support to the objeel <>r l>ody 
to be moved. Obtain help when moving a heavy 
object or unmanageable patient. 

B. Work in unison, give signal before starting 
activity. 

Methods of Moving and Lifting 
A. Prepare the patient and unit 

1. Tell the patient exactly what i- to be done 
and how he may help. 

2. Bring all needed equipment to the unit. 



176 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



3. Lock the wheels of the bed. 

4. Fold all bedding and clothing so that the 
patient will not be hampered by them and yet will 
not be exposed. 

B. Assume the correct position 

1. Stand, facing in the direction of the move to 
be made, with the feet apart, one foot well in front 
of the other. 




B3 a 4 



Figure 198. — Diagram. Body in Correct Position for Moving or 
Lifting. 

2. Stoop to working level by flexing knees, keep- 
ing back straight. 

3. Place arms under patient, keeping your el- 
bows close to the body. 

4. Set pelvis by tensing the abdominal and 
gluteal muscles simultaneously. 

C. Move or lift patient by shifting own weight 
from one foot to the other 

1. To move patient toward you, let arms holding 
the patient slide on the bed, shift your weight 
from front to rear foot. 




CI C2 c 3 C4 

Figure 199. — Body in Motion When Moving or Lifting. 

2. To move the patient away from you, let arms 
holding the patient slide on the bed, shift your 
weight from the rear to the front foot. 



3. To lift the patient, keep elbows close to your 
body, straighten knees, equal weight on both feet. 

4. To lower patient, keep elbows close to your 
body, flex knees to working level, equal weight on 
both feet. 

To Move a Patient Up in Bed (One Corps- 
man) 

Loosen drawsheet. Flex patient's knees, ask 
him to grasp rungs at head of bed. Assume the 
correct position behind head of bed. Grasp draw- 
sheet under pillow at patient's head. Corpsman 
gives signal and moves patient by shifting own 
weight from front to rear foot. To pull up a 
mattress: Flex knees to working level — grasp 
underside of mattress and use the same method. 




Figure 200. — To Move a Patient Up in Bed. 

To Move a Patient Up in Bed When He Is 
Able To Assist 

Assume the correct position at side of bed. 
Ask patient to flex his knees and to grasp rungs at 
head of bed. Place one arm under patient's shoul- 
ders and one under the buttocks. At corpsman's 
signal, patient pushes with his heels, straightens 
knees, flexes elbows. Corpsman assists by shifting 
own weight from rear to front foot. 



NURSING AND NURSING PROCEDURES 



177 




Figure 201. — To Move a Patient Up in Bed When He is Able to 
Assist. 

To Move a Helpless Patient Up in Bed With 
a Drawsheet (Two Corpsmen) 

A corpsman stands at each side of bed. Loosen 
and roll drawsheet fairly close t<> patient. Flex 
patient's knees. Both corpsmen assume the cor- 
rect position. At first corpsman's signal both 
move patient up in bed by shifting their weight 
from rear to front feet. 

To pull up a mattress grasp underside of mat- 
tress, flea knees to working level ami use tin- same 
method. 





Figure 203. — To Help the Patient Sit Up in Bed. 

your shoulder. I'm- other arm as Support for 

patient's head. (Jive signal, raise patient by 

shifting own weight from front to rear foot. See 
"Back rest position" for supports 

To Move a Helpless Patient Up in Bed 
(Two Corpsmen) 

A corpsman assumes the correct position 
each Bide of bed. Flex patient's knees, ask him to 



Figure 202. — To Move a Helpless Patient Up in Bed With a 
Drawsheet (Two Corpsmen). 

To Help the Patient Sit Up in Bed 

Assume the correct position at side of bed 

Slip near arm under patient'.- near ,-houlder. 

Ask patient to place his arm into same position on Figure 204. — To Move Helpless Patient Up in Bed (Two Corpsmen). 







178 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



make himself rigid. Both corpsmen slide arms 
under patient's head and shoulders and under 
patient's buttocks — lock wrists. At one corps- 
man's signal both move patient by shifting their 
weight from rear to front feet. 

To Turn a Patient on His Side 

Assume the correct position at side of bed 
toward which patient is to be turned. Flex pa- 
tient's knees. Place your hands on patient's far 
shoulder and hip. Slowly and gently turn patient 
toward you by shifting own weight from the front 
to the rear foot. Check patient's shoulder align- 
ment. See "Side lying position" for correct 
supports. 




Figure 205. — To Turn a Patient on His Side. 

To Help the Patient Sit Up on Side of Bed 

Dress patient in pajamas. Fanfold covers to 
foot of bed. Flex patient's knees, turn him on 
his side. Assume the correct position. Place one 
arm under patient's shoulder, the other behind 
the knees with hand under his lower thigh. Ask 
patient to place his hands around your neck or on 



your shoulders. Give signal, slowly bring patient 
to sitting position by straightening your knees as 
you shift weight from front to the rear foot. Sup- 
port patient's feet on stool or chair. 




Figure 206. — To Help the Patient Sit Up on Side of Bed. 

To Help the Patient Out of Bed Into Chair 

Place chair parallel to bed. Bring patient to a 
sitting position on side of bed. Dress him in bath- 




Figure 207. — To Help the Patient Out of Bed into Chair. 



NURSING AND NURSING PROCEDURES 



179 



robe and slippers. Allow patient to -it on Bide of 
bed until he is accustomed to this position. \-- 
sume the correct position in front <>f patient 
Ask patient to place his hands on your Bhoulders. 
Place a hand on each Bide of the patient, midway 
between his axilla and hip. Supporting patient, 
allow him to slide off bed and stand on floor, Pivot 
with patient, lower him into chair h\ flexing your 
knees, shifting weight from rear to front foot. 
keeping your back si raight 

To Help the Patient Into Wheel Chair 

Place chair against bedside table or have an- 
other corpsman hold it. Fold hark foot rests. 
Follow instructions "To help the patient out of 




Figure 208. — To Help the Patient into a Wheel Chair. 

bed t<> a chair." Assume the correct position of 
deep knee and hip tlexion to adjust foot rests. 
For wheel chairs with adjustable knee rests, fold 
hack knee rests until patient is seated, then adjust 
them. 



To Move Patient From Bed to Stretcher 

1'h.t stretcher at right angles to the bed. 
Three corpsinen assume the correct position at 
the same Bide of bed. First corpsman places 

one arm under patient's shoulder-, supporting 
I he head on I he crook of hi- arm. the other 

arm under patient's back. Second corpsman 

places his arm- under patient's hack and 




Figure 209. — To Move the Patient from Bed to Stretcher. 

thighs. Third corpsman places hi- arms under 

patient's thighs and calves. At first corp-maii's 

signal, all slide patient to edge of bed. All corps- 
men again assume the correct position and at 
fii-.-t corpsman's signal, all lift by straightening 

knee-: then turn and place patient on stretcher. 
To move the patient from Stretcher to Led — use 

same method. 

To Move an Injured Arm or Leg 
Place pillows in readme-- to support extremity. 

Place both hands beneath the injured limb, at 
joints above and below the sit,. ( ,f injury. K 
limb slowly and gently. Place extremity on pil- 
low, being -me the entire limb i^ supported. The 
toe- or hands should he slightly higher than the 

rest of the extremity. 



1 ) 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 210. — To Move an Injured Arm or Leg. 

Devices and Positions for the Comfort of 
the Patient 

All devices used for the patient's comfort 
should : 

Be large enough to support a part along its 
entire length. 

Be firm enough to support, yet not cause pres- 
sure. 

Promote correct anatomical alignment. 

Conform to part of body being supported. 




Figure 211. — Bed and Attachments. 

The Gatch bed (fig. 211) allows the patient's 
position to be changed with the least exertion to 
him. Patients are all different sizes and heights. 
The breaks in the bed frames for the back and 
knee rests are in the same place on all beds. 
Therefore, in most instances, the knee rest will not 
be usable when the back rest is elevated and vice 
versa. The knees may be flexed by use of a pil- 
low, rolled sheet, towel, or blanket. The feet 
should be supported so that they are at right angles 
to the bed (as in standing position). 



Fracture board (fig. 211). — A board the width 
and length of the mattress used to prevent sagging 
of the mattress. Used particularly in the care 
of patients with back injuries or fractures. 

Balkan frame (fig. 211). — An overhead appa- 
ratus attached to the bed providing a trapeze and 
attachments for traction. Used for patients who 
are in casts or who are paraplegics. 




WRONG 




RIGHT 

Figure 212. — Proper Use of the Gatch Bed. 

Pillows. — Various sizes may be used, depending 
upon the purpose. Place pillows in rubber cases 
when there is a possibility of soiling them. Fol- 
low the rules for devices of comfort. 

Footboard. — A board the width of the bed and 
at least three inches higher than the patient's toes 




Figure 213. — Footboard. 



NURSING AND NURSING PROCEDURES 



181 



may be used to support the feet. This board will 
help the patient stay in the correct position bj 
preventing his slipping down in bed and will pre- 
vent-the bedding from pressing on bis toes. 

Air ring. — An air ring may be used to relieve 
pressure on the coccyx, hip-, or on any pari of tin* 
body. The ring should be inflated just enough 
>(> raise the part off the bed. To inflate: Place a 
paper straw into valve of ring (or cover valve 
with gauze). Blow up until one-third full of air, 
close valve. 




Figure 214. — Inflating Air Ring. 

Place ring inside a cotton pillow cover. Place 
ring under patient so that the part to be protected 
ia directly over the hole of the ring. 

Precautions 

1. Be sure valve of ring is away from patient's 
body. (Example: between legs when used to re- 
lieve pressure on coccyx.) 

_'. If ring is loo hard after it is under the 
patient, open valve and release some air to lit the 
patient. A hard ring will cause more pressure 
than no ring at all. A soft ring does not relieve 
pressure. 

Cotton rings (doughnuts). — Ma\ be used to 
relieve pressure on bony prominences (heel-. 

ankles, elbows, -boulder blades) . To make cot Ion 
rings take cotton wadding of sufficient size to 
support area. Form into a circle: wind '1- or 3- 
inch bandage around cotton fo make an even, 
fairly linn ring. Finish bandage with a small 
piece of adhesive tape. 

Notk. — Where available, sponge rubber oil to lit the 
pari in in- supported, is recommended. 

-1 isc.6°— 53 13 




L 



Figure 215. — Making Doughnut. 



Figure 216. — Placement of Doughnut. 

Cradles are frames of various aizes used to keep 
weight of bedclothes oil patient'- legs, toes, or 
entire body. Anchor cradle to bed h\ tying to 
-prin<: or rung- of lied with bandage or string. 

Precaution. — Be sure patient has sufficient 
covers. He may need an e.\t i a blanket over uppei 
pari of bed. 

Sandbags may be used to immobilize or -up- 
port an ext remity. ( over bag with a pillow case. 
(Special cover- for sandbag- may be requested to 
be made by the linen room, i 

Precaution. — Be sure sandbag i> long enough 

to Support cut ire limb. 

Positions of Comfort for the Patient 
To provide good posture for the patient 

1. Support natural spinal curve- by use of back 
rests, pillows, air rings, etc. 

•_'. Support feet at right angles to the legs by 
use of footboard-, sandbag.-, etc. 

3. Change patient's position frequently to pie- 
vent pressure on any one part id' the body, to 
avoid strain on joints, and to prevent deformities. 

I. Encourage patient to move about in bed. lo 
provide exercise, to promote circulation, ami to 
maintain good joint movement and good muscle 
tone. 

5. Figure •_' 17 illustrates the four principal posi- 
tions of comfort for the patient. 

Devices for the Safety of the Patient 

The patient mu-i be protected from injuring 

himself or oiher-. The basic safety asure l<> 

protect all pat ients is to have all equipment in good 

working order. Some patient- require additional 

protection, Buch as side bar-, -beet or leather re 

strain!-. 



1 o2 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



SUPINE— BACK LYING POSITION 




Support feet with 
covered board or 
weighted box 



Maintain slight flexion 
of knees with a folded 
both towel or small 
pillow 



Support lumbar region Support shoulders and 

with a folded sheet head with a pillow 

or firm small pillow starting well under 

shoulders 



PRONE — FACE LYING POSITION 




1 



Place heels against board. 
Support onkle joint with 
folded bath towel 



Support abdomen with 
firm small pillow or 
folded sheet 



Support shoulder with 
folded both towel 



SIDE LYING POSITION 




f t 

Support upper leg in 

abduction with folded 

blankets covered by sheet 



Support upper arm in 
abduction with folded 
pillows 



Support heod with 
small pillow 



FOWLER'S— BACK REST POSITION 




Support feet with 
covered board or 
weighted box 



Maintain knee flexion 
with folded sheet 
or bath towel 



Note placement of 
pillows along entire back 



Note: Bend of hips 
at bend of mattress 



Support arms in abduction and flexion with folded pillows (Not shown) 



Figure 217. — Positions for Patient's Comfort. Turn page around. Note how anatomical alignment is 

maintained in all positions. 



NURSING AND NURSING PROCEDURES 



183 



Side bars (ii<r. -Jl 1 ). — Side bars are metal bars, 
the length of the bed, that Berve to keep the patient 
in bed. Some beds are equipped with bars thai 
slide down when no! in use much like a child's 
ciib. There are detachable bars available Eor 
other beds. Side bars are used Eor patients who 
are confused, delirious, under sedation, or uncon- 
scious. They may also be w^'d as a precautionary 
measure Eor patients who are blind or who have 
bad eye surgery. 

Sheet Restraints 

1. Tucking in the top bedding along the sides of 
the bed may provide enough protection for the 
patient. 




Figure 218. — Clove Hitch Sheet Restraint. 

2. Folding a sheet in quarters and applying it 
across the patient's chesl and t yin«r it to the bars 

under the bed may he used. A doctor's order is 
required. Care must he taken that this restraint 
does not interfere with the patient's respiration. 

3. Foldings sheet diagonally and applying it to 

the wrist or ankle by means of a clove hitch. A 
doctor's order is required. Care must he taken that 
patient's skin does not become chafed. 

Leather Ankle and Wrist Restraints 

These restraints MUST have a doctor's order: 
must he padded: must be loose enough to permit 
circulation of the part- of the body restrained; 
must he placed on opposite sides of the body ( right 
wrist, left ankle) : must he -Jack enough to allow 
some body movement. 

Applying restraints 

1. Pad the wrist or ankle with towel or cotton 
wadding. 



•_'. Place «uil over pad. 

'■'•. PaSS -trap through loop of cuff and under 
bar of bed. 

I. Allow enough -lack in the -trap to permit 

movement. 

.">. Lock -i rap. 

(J. Watch patient Eor signs of chafing, Burning, 
or pressure -ore-. 

Personal Cleanliness of the Patients 

The need for personal cleanliness of a -irk per 
son is as great or greater than that for a well 
person. The care of the -kin, mouth and hair fol- 
low- t he same genera] outline yon do in your daily 
life. The amount of assistance the patient will 
need from you in attending to his personal clean- 
liness will depend upon I he amount of activity 
permitted him b\ the doctor, hi- general and local 

condition. Alosl patients prefer t<> <h» a- much for 
themselves a.- possible; others will need to be en- 
couraged to assume their own care. 

Oral Hygiene — Care of the Mouth 

Purpose: To keep mouth clean, refresh patient : 

to prevent sordes, mouth odors; to stimulate 
appetite. 

Indicated 

Morning and evening for all patient-. 

Every 1 or •_' hour- for pat ient- w ho have mouth 
injuries or surgery; have -ore inflamed mouths: 
are on "nothing by mouth." 

Every •_' to 1 hours for patient- who have Eever; 
are unconscious, seriously ill, or dying, 

Equipment 
( Mass of water. 
( hirved basin. 
Tooth brush, dentifrice. 
Hand towel. 

Procedure 

When patient is able to help himself 

1. Place patient in comfortable position on 

backrest or on his aide. 

•_'. Arrange equipment within his reach on bed- 
side table. 

:;. Remove equipment promptly when finished. 

When patient needs some assistance 
1. Turn patient on side. 



Iti 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 219. — Assisting Patient with Oral Hygiene. 

2. Place towel under his chin and over bedding 
(fig. 219). 

3. Pour water over brush; place dentifrice on 
brush. 

4. Give patient his brush; hold curved basin 
under his chin while he brushes teeth. 

5. Give water to rinse mouth ; take toothbrush. 

6. Remove basin; wipe lips and chin with towel. 

7. Make patient comfortable. 

8. Remove equipment from unit. 

Patient unable to help himself 

1. Add drinking tube and tongue depressor to 
equipment. 

2. Proceed as above, doing all steps for patient. 

Brushing teeth : 

Start at front teeth, brush from one side of 
mouth to the other. 

Brush outer surfaces of the upper and lower 
teeth toward the biting edge. 

Do inner surfaces of teeth in same manner. 

3. Use drinking tube to rinse patient's mouth. 
Special mouth care 

Patients requiring special mouth care are the 
unconscious, dying patient, or one who has had 
surgery, injuries, or sores of the mouth. 

Do not use force to clean wounds, to clean 
around wires, or to remove crusts. 

Equipment: 

Seven cotton applicators. 
Mouth wash ( 1 : 3 solution) 
Glass of water. 




Figure 220. — Equipment for Special Mouth Care. 

Tube. 

Hand towel. 
Curved basin. 

Tongue depressor wrapped with gauze bandage. 
Paper wipes. 
Bag for waste 
Mineral oil. 

One ounce bulb syringe if patient is unable to 
use tube. 

Procedure 

1. Follow instructions as above. Moisten ap- 
plicators in mouth wash. Use in the same manner 
as toothbrush. 

2. Use new applicator for each section of 
mouth; discard into bajr. 




Figure 221. — Mouth Irrigation. 



NURSING AND NURSING PROCEDURES 



185 



3. Use wrapped tongue depressor for cleansing 
tongue and holding moul li open. 

I. Use drinking tube to rinse mouth. It' pa 
tient is unable to use tube, turn his head to one Bide 
and gently irrigate mouth. Direct atreamofsol 
m ion to side of mouth. 

.'). Apply mineral oil t<> lips and gums. 

<>. Make patient comfortable, remove equip- 
ment 

Care of Equipment 

1. Rinse toothbrush under cold running water: 
replace in pat ient's bedside table. 

2. Discard waste in burnable trash can. 

3. Wash metalware with soap and water, boil 
20 minutes, dry and stow in proper place. 

I. Wa-li glassware with soap and water, boil 
L0 minutes: dry and stow in proper place. 

Charting 

Nursing note.-: Time, treatment, any unusual 
condition noted. 
Signature. 

Care of Dentures (False Teeth) 
Indicated: Plates and bridges should lie cared 

lor as often and in the same manner as natural 
teeth. 

Equipment 

( Hass or cup for teeth. 
Toothbrush and dent il'rice. 

Procedure 

1. Ask patient to place teeth in glass. 
± Take to utility room. 




•">. Place ha- in under tap in -ink and place folded 
towel or washcloth in basin as a preca itionary 
measure againsl breakage. 

I. Wash dentine- under warm running 
over basin. 

.">. Use pain •ni'- brush and water, rinse denture- 
well. 

6. Pul teeth in glass; return them lo patient. 

(are of Equipment 

Same a- for oral h\ giene. 

Morning Care (A. M. Care) " 

Purpose: To refresh ami prepare patient for 
breakfast. 

Indicated: For all bed patient-, l hour before 
breakfasl by night corpsman. 

Equipment 
Face basin one-half full of hot water. 

( rlaSS of water, curved ba-in. 

Pat ient's tool hbrush and dent ifri< e. 

Hand towel, washcloth. 

Soap in soap dish. 
( !omb. 

Procedure 

1. ( )ll'er bedpan or urinal. 

i'. I )«■ oral hygiene. 

.') Wash face and hand-. 

1. Prepare pat ient for breakfast : 

a. In correct position (Fowler's or on side). 

b. Clear top of bedside locker or overbed table 

for food t ray. 

Evening Care (P. M. Care) 

Purpose: To relax and prepare patient for the 
night. 

Indicated: For all bed and newly convalescent 

patient-. 

Equipment 

Same a- for a. in. 'are pin- alcohol and powder. 

Procedure 

1. Follow in-tin. lion- a- for a. m. .are. 

± Add back rub. 

:'. St raighten and tighten foundation bed, brush 
out crumbs, aid freshen pillow-. 



Figure 222. — Cleaning Dentures. 



i • ii rbtelcd Ort Load with equtp- 

iii. in i~ Add large pitcher "f li. • t v • - 

roi.i w.-.i- Diatrltata eqnlpnx .Mr to 

belp - then !•• i lire belp. 



1 B 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



4. Bring bedside locker within patient's reach. 

5. Give fresh drinking water. 

6. Place extra blanket at foot of bed if night 
is cool. 

Cleansing Baths 

Purpose: To clean, relax, and refresh patient; 
to stimulate circulation, aid in elimination of body 
wastes; to observe patient. 

Bed Bath 

Indicated: Daily for all bed patients, prefer- 
ably one hour before or after breakfast; newly 
admitted patients. 




Figure 223. — Equipment for Bed Bath. 

Equipment 

Bath basin or foot tub one-half full of hot 
water (110° F.). 
Soap in soap dish. 
Rubbing alcohol, 50 percent. 
Talcum powder. 
Nail stick. 
Nailbrush if needed. 
Oral hygiene equipment. 
Linen as needed. 
Pajamas. 
Bath towel. 
Hand towel. 
Washcloth. 



Points to Remember 

1. Use long, firm, smooth strokes in bathing. 

2. Wash all parts of the body ; soak hands and 
feet. 

3. Use washcloth mitten fashion; avoid dan- 
gling ends. 

4. Expose only that part being bathed. 




Figure 224. — Mitten Wash Cloth. 

5. Change water after bathing feet and when 
it becomes dirty, soapy, or cool. 

C>. Observe patient. Watch for signs of rash, 
scratching, pressure areas, vermin. Talk to pa- 
tient during bath ; find out how he feels. Any new 
pains ? Aches ? Worries ? Happy i 

7. Protect bedding with towel as each part is 
bathed. 

8. Keep linen off deck. Place soiled linen in 
rungs of bed or in hamper. 

Procedure — Preparation of patient and his unit 

1. Screen patient, close windows, and check 
temperature of ward (72°-75° F.). 

2. Tell patient what you are going to do. 

3. Offer bedpan and urinal. 

4. Gather equipment needed, except basin; 
bring to bedside. 

5. Do oral hygiene. 

6. Remove oral hygiene equipment; bring in 
basin of water. 

7. Lower backrest ; loosen top bedding at foot 
and sides of bed. 

8. Remove pillow ; strip and place on chair. 

9. Fold spread from top to bottom; pick up 
in center and place on back of chair. 

10. If ward is warm, blanket may be removed 
in same way. 

11. Remove jewelry ; place in drawer of bedside 
stand. 



NURSING AND NURSING PROCEDURES 



187 



Order of bath 

1. Eyes ( no so;i|>) . 

2. Face, neck, and ears. 

3. Far arm, hand, nails. 

4. Near arm, hand, nails. 

5. ('host. 

(>. Abdomen. 

7. Far leg, foot, nails. 
V War le<_ r . foot, nails. 

!>. Back, buttocks: Wash side-, back, buttocks; 

rinse and dry well. 

a. Pour alcohol into hands; then apply evenly 
to pat tent's back. Hub until back is dr\ . 

b. Sprinkle powder into hands: then apply 
to pat icnt V hack. Rub for "> minutes. Use long, 
smooth, firm stroke-: even pressure; establish 
definite rhythm: keep hands on back for dura- 
tion of back rub. 

10. Genitals -patient usually prefers to wash 
himself; corpsman will do so if patient is too ill. 




Figure 225. — The Bed Bath. Patient's sheet is turned back to 
show method of draping. 

After bath 

1. Put on pajamas, 

2. Comb hair. 

3. Make up bed. (See "Occupied bed.") 

4. Remove all equipment : leave unit clean and 
in order. 

5. Leave patient comfortable: 

a. In correct position. 

b. Call bell, fresh water, and bedside table 
within reach. 



<">. Clean equipment. (See u Use and re >>f 
equipment." i 
Male patienl may Bhave himself either with 

hi- a. iii. rule or before hi- hath. When corp-man 
must -have [patient, do SO before bath or after 

lunch, before visit ing hours. 

Female patient: Give patient all her makeup 

equipment after the bed 1- finished. She will 
apply makeup while unit i- being straightened. 

When patient i> able to bathe himself: 

1. Bring equipment within hi- reach. 

2. Assist him a- necessary i back, legs, feet i. 
:'). Make up bed; Bquare-away unit. 

Tub Bath 
Equipment 

Warm bathroom l 72 7:. I'.i. 
Slool or chair. 
Bath mat. 
Pajamas, bathrobe. 
Bath towel, washcloth. 
Soap in soap dish. 

Procedure 

1. Have bathroom warm without drafts. 

2. Draw water for hat h. Temperature of water 
should be comfortably warm. 

."». Place bath mat on deck in front of tub. 

I. Assist patient to undress; to i_ r et into tub: to 

wash and Avy himself; to die--: to return to his 
bed. 

.">. Patient may carry out the entire procedure 
himself if he is able. Do not allow the door of 
the bathroom to be locked ! 

Precautions 

1. Do not have the water to., hot or too cold. 

2. Do not have the bathroom -o hot a- to . 
chilling when patient return- to ward. 

•"). I'se proper body mechanic- when stooping 
over to assist patient. 

Charting 

Nursing note-: Time, bath, observations made. 
>ii_ r nature. 

Bedpan and Urinal Service 

Placing and removing the bedpan 

Purpose: To maintain proper elimination with 
lea-i . ; 1011 to the patient. 



188 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Equipment: Bedpan, bedpan cover, and toilet 
paper. 

Procedure 

1. Screen unit. Take covered bedpan and toilet 
paper to bedside. (Bedpan may be warmed by 
running hot water over it and then drying it.) 

2. Remove bedpan cover and tuck under mat- 
tress on side of the bed. 

3. Lift bed covers ; remove any air cushions and 
pillows. 

4. Pull pa jama coat above waist and pa jama 
pants down to knees. 

5. Flex patient's knees, slip one hand under the 
patient's back, raise his hips, and with the other 
hand, slip pan into place. (If patient is able to 
help himself, ask him to bend his knees, press heels 
against the bed, and raise his hips while you place 
the pan). 12 

6. Place toilet paper and bell cord within reach. 

7. Leave patient alone unless he is too ill. 

8. Answer light immediately and remove pan- 
quickly. 

9. For patient unable to cleanse himself: Ask 
patient to turn on his side off the pan ; take toilet 
paper and clean patient. 

10. Cover pan and place it on chair. 

11. Fix bedding: leave patient in comfortable 
position. 

12. Take pan to utility room ; look at contents. 
Note amount, consistency, color, odor, and unusual 
appearance (mucus, worms) : 

Normal stool — brown, formed, soft. 

Blood in stool — black, tarry. 

Absence of bile in stool — clay-colored gray. 

13. Provide patient with basin of water, soap 
and towel to wash his hands. 

14. Care of bedpan : 

Automatic washer : Place pan in sterilizer, 
close door, and push flusher valve. Push and 
hold steam valve for one minute. Remove pan 
and stow in rack. 

Manual washing : Add cold water to bedpan 
and empty contents into hopper ; clean bedpan 
with brush and hot soapy water. Boil pan in 
utensil sterilizer for 20 minutes. 



Urinal Service 

Equipment : Urinal and cover. 
Procedure 

1. Bring covered urinal to patient. 

2. Remove urinal promptly. 

3. Clean urinal same as for bedpan. 

Measured Intake and Output 

Purpose : To compare the intake and output of 
fluids by the patient. 

Procedure 

1. Place a sheet of paper and pencil at patient's 
bedside. 13 

2. Rule sheet into columns for time, intake, 
and output. 

3. When the patient drinks fluids, measure and 
record in time and intake columns. 14 

4. When patient voids, measure and record in 
time and output columns. 

5. Total intake and output columns at 2400. 

6. Start a new sheet at 0001. 

Care of Incontinent Patient 

Purpose : To keep the patient as clean and dry 
as possible ; to prevent decubitus ulcers. 

Incontinence may be due to : 

1. Loss of muscle tone or paralysis of the anal 
and/or urethral sphincter. 

2. Urinary retention with overflow. 

3. Bedpan or urinal not given when needed. 

Care 

1. Answer patient's calls promptly. 

2. Change bedding at once when wet or soiled. 

3. Wash patient with soap and water each time 
he is wet or soiled. 

4. Watch for signs of burning, redness, or 
breaks in the skin. 

5. Give frequent back rubs alternating oil and 
alcohol. 

6. Place patient on a bedpan at frequent inter- 
vals. 

7. Place a urinal for a male patient. Be sure 
it is level and will not tip over. Empty, clean, and 
replace frequently. 



u Another method : Roll patient to side of the bed. place the pan 
against his buttocks, and then roll him back to the center of the 
bed on the pan. Caution : If the patient is heavy or unable to 
help, ask another corpsman to help you. 



13 When patient is capable, show him how to keep his own 
record. 

11 Include as intake — fluids given by intravenous or hypoder- 
mocylsis. Include as output — fluids lost by vomiting, gastric or 
urinary drainage. 



NURSING AND NURSING PROCEDURES 



189 



8. Use a large disposable pad or covered rubber 

.sheet under the patient V In mocks. 

9. Doctor may order an indwelling catheter 
to keep the patient dry. See "indwelling catheter" 
and "simple drainage." 

Care of Bedsores ( Decubitus Ulcer, Pressure 
Sore) 

A bedsore is an ulcerated area due to poor cir- 
culation to a pari as the result of pressure. 'The 
areas -t likely to develop bedsores are the el- 
bows, the heels, the rocr\ \, hip-, buttocks, ankle-, 
toes, shoulder blades, ear.-, and hack of the head. 
All patient- confined to lied are su-ceptible to 

bedsores. The patients most likely to develop 
bedsores are those with lowered vitality due to 
prolonged illness; the emaciated patients; para- 
lyzed patients: unconscious patients: obese pa- 
tients; the edematous patients; diabetic, cardiac, 
or nephritic patient-: those with casts, splints, 
bandages, Or in traction. 







Figure 226. — A Bedsore. 

Causes 

1. Constant pressure on an area due to lying 
in one position too long. 

2. Splint-, cast-, bandages, or traction improp- 
erly applied. 

3. Moisture due to sweat, urine, l'.cc-, water, 
pus, or other discharp's. 

4. Friction due to too tighl or wrinkled 
bedding. 

.">. Pimples or breaks in the -kin. 
6. Faulty use of the bedpan. 



Occiput 



Scapula 




Sacrum 



Elbow 



Anterior 
and posterior 
superior spines 
of hip bone 
(ilium) 



Greater trochanter 
of femur 



Tuberosity of 
ischium 



Heel 



Figure 227. — Areas Susceptible to Bedsores. 

Symptoms 

1. Blanching <>f the skin which quickly turns 
red when the cause of the pre— me i- removed. 

•2. Patient complains of nuinbnc--. tingling, 01 

tenderness. 

:'>. Bluish or mottled discoloration of the skin. 
I. Break down of the skin. 



• >. 



Ulceration. 



Prevention 

1. [lisped the -kin of all bed patient- every day 
di ring the hath and morning and evening care. 
•J. Change the patient*- position every •_' hour-. 
::. Keep patient and hi- bed clean and dry. 

I. Rub suspected areas frequently, alternate oil 

and alcohol nib-. 



19 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



5. Wash, dry, and powder patient's skin each 
time he is incontinent. 

6. Inspect all appliances frequently. 

Treatment 

1. Prevent bedsores by following instructions 
under prevention. 

2. Report any suspicious areas immediately. 

3. If skin is broken : 

a. Wash with soap and water; dry well. 

b. Rub the surrounding area with alcohol. 

c. Follow doctor's orders for other treatment, 
or medication. 

Serving Diets 

The patient's appetite is stimulated by the time 
of day, by the sight, smell, and taste of food and 
by the manner and condition in which it is served 
to him. The ward should be quiet, odorless, and 
in readiness for meals. No treatments should be 
done, sick calls made, or visitors permitted during 
meal hours. 

Standard diets 

Liquid. 

Clear — tea, coffee, broth, gelatines. 

Full — added strained soups, juices, ice cream. 

Soft — add chicken, beef; bland vegetables, 
puddings. 

Light — add light salads, vegetables, lamb, veal, 
dessert, plain cake. 

Regular — full house diet. 

Special diets : For specific conditions. Certain 
foods ai*e increased or decreased according to 
needs of the patient. 

Preparation of the patient 

Bed patient : 

1. Clear bedside stand or overbed table. 

2. Bring stand or table within patient's reach. 

3. Place patient in sitting position or on his side. 

4. Tuck a hand towel under his chin and across 
his chest. 

Up patient : 

Remind patient to be at his bedside when meals 
are served. 

Where possible, serve up patients at a table 
in solarium. 



Preparation of food trays 

Wash your hands ! 

1. Inspect dishes, silverware, and trays for 
cleanliness. 

2. Use clean serving utensils for serving food. 

3. Follow diet list posted in ward diet kitchen. 

4. Do not smoke while preparing, setting-up, 
or serving trays. 

Setting-up food trays 

1. Sugar, salt, pepper, and water go on most 
trays, but follow diet lists ! 

Diabetic diets, omit sugar. 

Low salt, omit salt. 

Ulcer, omit salt and pepper. 

Restricted fluid, omit salt, pepper, water. 

Low fat, omit butter. 

2. Place cold foods on tray — bread, butter, salad, 
dessert, milk. Wheel trays and food cart with 
serving utensils to center of the ward. 

Serving trays 

Be sure you have the right diet on the right 
tray for the right person ! 

1. Serve small portions; patient may ask for 
seconds. 

2 Place foods in center of dishes; avoid spill- 
ing over sides. 

3. Fill glasses, cups, and bowls to one-half 
inch from the top. 




Figure 228. — Food Service. 



NURSING AND NURSING PROCEDURES 



191 



I. Place lmt foods on each tray a- it ia served. 

;. Cut food into bite size and butter tin- bread 
for those patients unable to use knives. 

6 Place tray in front of the patienl bo thai the 
knife is on right side of the tray and all * 1 i ~ 1 1 * - - 
are within his reach. 

Order of serving trays 

1. Serve bed patients who are able t<> feed them 
selves. 

2. Serve up patient-. 

■".. Hold trays for helpless patients until corps- 
inen are ready to Hvvd t hem. 

Collecting trays 

1. Do not hurry your patients ! (Jive them time 
to enjoy their food. 

2. Collect trays on utility cart. Take to door 
of ward diet kitchen. 

3. Remove trays one at a time. 

a. Scrape solids from dishes into garbage can : 
stack dishes. 

b. Pour liquids down sink: stack cups and 
glasses. 

c. Wipe, and stack t rays. 

d. Send trays, dishes, and silver to main 
galley. 

4. Automatic dishwashers and sterilizers — fol- 
low instructions of manufacturer. Check temper- 
ature control. Follow step 56 if questionable. 

5. Manual dishwashing and disinfection. 

a. Wash dishes, silverware, and trays with 
warm, soapy water. 

b. Immerse dishes and silverware in boiling 
water fori minute: allow to air dry. 

Feeding the Helpless Patient 

1. Place the patient in a sitting position unless 
otherwise ordered by the doctor. 

2. Place a hand towel across the patient's chest : 
t uck a napkin under his chin. 

3. Place tray on overbed table or on bedside 
stand. 

I. Give the patient a piece of buttered bread if 
he is able to hold it. 

."). Feed the patient in the order in which he 
likes to be fed. 

»i. Offer fluid during the meal. Use a drinking 
tube. 

7. Do not rush your patient — give a small 
amount of food at one time: allow patient to 




Figure 229. — Feeding a Helpless Patient. 

chew and swallow food before offering the next 
spoonful. 

8. If patient i- inclined to talk, talk with him. 
It is an excellent time to observe your patient. 
Find out his likes and dislikes in food, part iciilarly 
if his appetite i- poor or if he i- on a social d 

!>. When he is finished, lower backrest : fix his 
bed so that he may rest 

10. Take tray to diet kitchen: scrape and stack 
tray. 

11. Note amount of food he has eaten: record 
amount of fluid if on measured intake and output. 

Feeding the Blind Patient 

1. Follow steps 1. 2, and :'» in feeding a helpless 
patient. 

2. Tell patient what food i- on the tray. 
:'>. As you U-rA him : 

a. Tell him what you are offering him. 
whether hot or cold, and whether it i- in a Bpoon, 
cup, or drinking tube. 

/>. Allow him to hold a piece of 1. uttered bread 
if he wishes. 

0. If doctor permits, -tart patient toward 
helping himself. 

(1) Always Set the tray in the -ame place in 
front of him. 

i ■_' i Always place the dishes in the .-ame order 
on the tray. 

i .; i \ \ - place the Bame type of food in the 
same clockwise position on dinner plate. 



192 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



(4) Fill cups and glasses only half full to avoid 
his spilling fluids. 

(5) Go slowly — help him by degrees; a little 
progress each day will help build his confidence. 
Stand by until he is sure and is confident of 
himself. 

Feeding an Infant 
Preparation of formula 

1. Wash your hands. 

2. Obtain the right formula for the right baby 
from the refrigerator. 

3. Place the bottle in a pan of water sufficiently 
hot to heat the formula to about 100° F. 

Preparation of the infant 

1. Don nursery gown, change baby's diaper, and 
wrap baby in baby blanket. 

2. Wash your hands. 

Feeding the infant 

1. Pick up the baby, cradling and supporting 
his head and back on your arm. Sit down in a 
straight-backed chair. 

2. Pick up the bottle of formula ; sprinkle a few 
drops on the inner surface of your wrist to test 
the temperature of the formula ( should be slightly 
warmer than body temperature). 

3. Place nipple in the baby's mouth. Be sure 
the neck of the bottle is always filled with formula. 

4. Note the rate of flow of the formula. 

A flow too rapid may cause the baby to choke 
or to lose the formula and may be due to the 



nipple being too soft and old or nipple holes 
being too large. Replace nipple. 

A flow too slow may cause the baby to work 
too hard to get the formula and may be due 
to the nipple holes being too small or clogged 
(replace nipple) or to the presence of an air 
lock. (Stop feeding: hold bottle upright for 
a second and then continue feeding bein<r sure 
the neck of the bottle is always filled with 
formula.) 




Figure 230. — Feeding an Infant. 



PREVENTING THE SPREAD OF INFECTION 

Review — Chapter VI, "The Nature of Communicable Diseases" 

"The Body's Defenses Against Disease" 

Chapter VII, "The Antiseptics" 



The measures used to prevent the spread of 
infection among all patients have already been 
mentioned. They are repeated here to stress 
their importance. 

1. Keep space between beds at 8 foot center 
intervals. 

2. Have for each patient a complete bedside 
unit: bed, bedside locker, and chair. 



3. Keep patient's belongings within his unit. 

4. Consider deck, inside of sinks and hoppers 
as contaminated. 

5. Bring only clean articles and utensils to the 
patient; disinfect or sterilize them after he uses 
them. 

6. Sterilize dishes after each meal. 



NURSING AND NURSING PROCEDURES 



193 



7. Consider all body discharges and excreta as 

possible disease carriers and neat them as Buch. 

B. Wash hands after the care of each patient 

and after each task. Use plenty of soap (to 
emulsify the dirt), friction (to loosen the dirt), 
and running water iti> gel rid of the dirt). 

When a patient is known to have a cominu- 
tlicable disease or ha- a wound, additional inea- 

ares are used to prevent the spread of infection. 

Medical asepl ic technique is used in caring for a 
patient with a communicable disease. The pur- 
pose of this technique IS to confine the disease to 
the patient and to protect the worker and other 
patients from the infection. The technique con- 
sists of isolating the patient in a separate ward, 
room or unit; the concurrent disinfection of ma- 
terials and utensils coming from patient, and the 
use of protective clothing by the worker while 
caring for the pat ient. 

Surgical aseptic technique is used in caring lor 
■a patient with a wound. The purpose of this 
technique is to protect the patient from infection 
that is possibly carried in the air. by the worker, 
by worker's equipment, or by other patients. 
This technique Consists of segregating the patient 
in a separate ward, room or unit: sterilization of 
all articles going to the patient's wound and some- 
times the wearing of sterilized clothing by the 
worker. 



Mt.dilicat ion- of both techniques I in 

various ways in many departments of the hospital. 

In pediatric and nursery ward-. \1 1 

gowns are used to protect the infant or child from 
possible infection by the worker. 

In surgical wards. — All articles coming in di- 
rect contact with the wound :uv sterile. Masks 
and gowns maj also he worn when caring for a 
patient with extensive burns or wounds. 

In all wards. Article- used for injection-, irri- 
gations, ami instillations arc sterile. 

These techniques serve a dual purpose. They 

protect both the worker and the patient. There 

are definite met hod- of handling contaminated and 

Sterile articles to protect the worker and the pa- 
tient. These methods must he followed faithfully 
to give the protection they were designed to ;_ r i\e. 
Much depends upon the individual honesty of the 
worker and upon hi- learning to recognize when a 
thing is clean — free from pathogenic organisms; 
sterile — free from all organisms : contaminated — 
has been in contact with pathogenic organisms; 
and unsterile — has been in contact with organisms 
(not necessarily pathogenic) and i- not usable in 
sterile field. 

The most important single factor in prevent- 
ing the spread of infection is adequate hand- 
washing. 



Table I.— COMPARISON OF MEDICAL AND SURGICAL ASEPTIC TECHNIQUES 



Medical aseptic technique 

Indicated in presence of communicable disease. 
Emphasis on cleanliness (freedom from patho- 
genic organisms) . 

Preventing the spread of infection 

Purpose: To confine disease or infection to the 
patient. To protect other patients and workers 
from additional disease. To maintain cleanli- 
ness. To protect patient from other infections 
which may cause serious complications in his 
disease. 

Isolation- 

Patient with eoniinunicahle disease i> separated 
from rest of hospital by room, ward, or area. 



Surgical aseptic technique 

Indicated in presence of open wound. 
Emphasis on sterility i freedom from all organ- 
isms). 

Preventing the spread <»f infection 

Purpose: To protect patient having open wound 
from possible disease of worker or other patients. 
To maintain -terilit \ . 



Isolation 

Patient i- operated upon in surgery a separate 
department awaj from rest of hospital. 

Patient with wound i- assigned to B 
ward. 



194 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Table I.— COMPARISON OF MEDICAL AND 
Medical aseptic technique 

Zone about unit is established as contaminated. 

Once an article touches a contaminated surface, 
it is contaminated. Nothing goes out of zone 
■without being sterilized, disinfected, or wrapped 
in a clean cover. 



SURGICAL ASEPTIC TECHNIQUES— Continued 
Surgical aseptic technique 

Zone about site of operation or wound is estab- 
lished as a sterile field. 

Once a sterile article touches an unsterile article, 
it is unsterile. Only sterile articles are brought 
into the sterile field. 



Handwashing 

Worker's hands and forearms are washed to 
protect other patients, workers, and self, from dis- 
ease of patient. 

Plenty of soap, water, and friction are used, 
rubbing well between fingers and around nails. 

Hands are held down over basin to allow water 
to drain off fingertips. 

Hands and arms are dried with paper towels. 

Lotion suggested to keep skin in good condition. 

Gowns 

Clean gowns are worn. 

Gowns are worn to protect the worker from 
patient's disease. 

Inside of gown is kept clean ; outside of gown is 
in contact with patient and his articles and there- 
fore is contaminated. 

Gown is worn in the care of one patient or group 
of patients with same disease. 

Caps 

Caps are worn to protect workers from disease- 
laden droplets or air-borne organisms. 

Masks 

Masks are worn to protect worker from inhaling 
disease organisms of patient. 

Masks also protect patient from worker (i. e., 
worker has cold) . 

Gloves 

Gloves are initially sterile. 

Gloves are worn to protect w T orker when han- 
dling articles carrying infectious material. 



Handwashing 

Worker's hands and forearms are scrubbed to 
prevent infecting patient. 

Plenty of soap, water, and friction are used, 
rubbing well between fingers and around nails. 
Brush may be used. 

Hands are held up under tap to allow water to 
drain off elbows. Hands and arms are dried with 
a sterile towel. 



Gowns 

In surgery, sterile gowns are worn. 

Gowns are worn to protect the patient from in- 
fection possibly carried by the worker. 

Outside of gown is in contact with sterile field — 
therefore must be kept sterile. 

Gown is worn for one operation only. 



Caps 

Caps are used to protect patients from possible 
infection carried by workers. 

Masks 

Masks are worn to protect an open wound and 
patient from disease organisms exhaled by worker. 

Masks also protect worker from inhaling dis- 
ease organisms of a patient. 

Gloves 

Gloves are sterile and worn to protect wound 
from organisms since hands cannot be sterilized. 

Gloves are in contact with sterile field; there- 
fore must be sterile. 



NURSING AND NURSING PROCEDURES 



195 



Table I.— COMPARISON OF MEDICAL AND SURGICAL ASEPTIC TECHNIQUES— Continued 

Medical aseptic technique Surgical Aseptic technique 

Linen Linen 



Requires special handling to protect ward and 
laundry workers. Placed inside clean bag or con- 
tainer, tagged "contaminated" and taken to laun- 
dry at special times. 

Where proper laundering facilities are avail- 
able, organisms are killed in laundering process. 

Where facilities are questionable, linen is auto- 
claved for 30 minutes before being sent to laundry 
or is soaked in disinfectant solution for 2 hours. 



Surgery : Has own supply. After laundering 
it is packed and sterilized by autoclave. Kept 
sterile until and during operation. 

On Ward : Linen used about wounds is packed 
in metal containers or wrapped in double muslin 
covers and sterilized by autoclave. 

Linen is kept sterile until used. 



For detailed discussion of techniques see "Medi- 
cal aseptic technique," pages 262-268, and "Sur- 
gical aseptic technique," pages 251-256; 295-300. 



SUGGESTED ADDITIONAL READING— UNIT II 



American Red Cross, Home Nursing, Philadel- 
phia : Blakiston Co., 1950. 

Dakin, Florence and Thompson, E. M., Simpli- 
fied Nursing, 4th ed. Philadelphia : J. B. Lip- 
pincott Co., 1951. Part VI, sec. 29-31. 

Fash, Bernice, Body Mechanics in Nursing Arts. 
New York : McGraw-Hill Book Co., 1946. 

McCulloch, Ernest C, Disinfection and Sterili- 
zation, 3d ed. Philadelphia : Lea and Febiger, 
1948. 

Montag, Mildred and Filson, Margaret, Nursing 
Arts. Philadelphia : W. B. Saunders Co., 1948. 
Parts II, III. Part V, Chap. 17-19. 



Smith, C. Richard, "Alcohol As a Disinfectant 
Against Tubercle Bacilli," Public Health Re- 
ports 62 : 36 (September 5, 1947) , pp. 1285-1295. 
Abstract : Bureau Medicine and Surgery News- 
letter 10:8 (February 1948). 

Stevenson, Jessie L., Posture and Nursing, 2d ed. 
New York : Joint Orthopedic Nursing Advisory 
Service of National Organization for Public 
Health Nursing and the National League of 
Nursing Education, 1948. 

Young, Helen and Lee, Eleanor and Associates. 
Essentials of Nursing. 2d ed. rev. New York : 
G. P. Putnam's Sons, 1948. Part II, sec. 4-12. 



Read the current issues of periodicals for the 
latest information on the care and comfort of your 
patient. 

Periodicals available at most stations are: 
Armed Forces Medical Technicians Bulletin and 
American Journal of Nursing. 



196 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



ASSISTING WITH AND PERFORMING DIAGNOSTIC AND THERAPEUTIC 

PROCEDURES— UNIT III 



Diagnostic and therapeutic procedures have so 
greatly increased in number, scope, and complex- 
ity, that the corpsman may find himself spending 
the greater portion of his time on duty assisting 
with or performing these procedures. 

In order to intelligently assist with or perforin 
these procedures the corpsman should know : 

1. How and why the procedure is done. 

2. What care the patient should have before, 
during, and after the procedure. 

3. What role he takes in the procedure; what 
part the doctor or technician assumes. 

4. What equipment is necessary for the pro- 
cedure; whether the equipment should be clean 
or sterile. 

5. The time of the day the procedure may be 
performed to obtain the best results. 

6. What symptoms and reactions are expected 
as a result of the procedure. What symptoms 
or signs of untoward reactions may occur. 



When assisting with or performing these pro- 
cedures, always strive to keep in mind that each 
one has been ordered by the doctor for a patient. 
The benefit the patient will derive from the pro- 
cedure will depend to a considerable degree upon 
your ability to explain the procedure sufficiently 
to him so that he understands what is to be done, 
why the procedure has been ordered, and how he 
may help to assure the success of the procedure. 

Diagnostic tests and examinations are presented 
in table form for quick and ready reference. All 
tests listed should be checked with local station 
orders since methods vary in different localities. 
The tables are preceded by general instructions 
for the preparation of the patient, collection of 
specimens, and for charting notes. 

Therapeutic procedures are discussed in sub- 
sequent sections. 



DIAGNOSTIC TESTS AND EXAMINATIONS 

Review — Local Station Orders 

Chapter II, Section Pertaining to the Anatomy or Physiology of the Part of the 

Body To Be Examined 

Chapter X, Section Pertaining to the Desired Test or Examination 



GENERAL INSTRUCTIONS 
Preparation of the patient 

Explain the test or examination to the patient. 

Show the patient how to cooperate to make a 
successful test or examination. 

Provide transportation (wheel chair, stretcher) 
when test or examination is performed in another 
ward or department. 

Care of the patient after test 

Relieve pain if present. 

Heat and serve food if meal has been withheld. 
Give bath or a. m. care if either have been 
omitted. 



Charting 

Nursing notes : 

1. Specimens: 

. Time of collection. 

Type of specimen. 

Name of test ordered. 

Amount of specimen in cc. if measurable. 

Any other item affecting the result of the 
test. 

Example: 1000: Bromosulfalein 25 mg. I. 
V. given by Dr. Jones. 1030 : blood specimen 
taken. 

2. Special tests or examinations: 
Time of the test. 

Name of the test. 



NURSING AND NURSING PROCEDURES 



197 



By whom the test was performed. 

Name of the doctor doing the test if done 
on the ward. 

Amount and description of fluid obtained if 
applicable. 

Special preparation of the patient for the 
test. 

Reaction of the patient to the test. 

Example: 1000: lumbar puncture by Dr. 
Jones. 5 cc. clear colorless spinal fluid ob- 
tained- Manometer pressure 150 mm. Pa- 
tient placed in prone position. Patient 
cautioned to remain flat in bed. 1030 : com- 
plains of headache. 

Collection of Specimens 

Observe the nine rights for collecting specimens. 
Be sure that — 

1. The right specimen, from 

2. The right patient, collected in 

3. The right manner, at 

4. The right time, into 



5. The right container, in 

6. The right amount, and with 

7. The right label, is taken to 

8. The right place in the laboratory, and handed 
to 

9. The right person. 

Precautions to observe when collecting speci- 
mens : 

1. Wash your hands before and after touching 
specimens and containers. 

2. Keep the outside of the container clean to 
protect other personnel handling specimen. 

3. Attach request for examination to the speci- 
men container with a rubber band, string or clip. 
Exception : Keep request separate when specimen 
is from a patient with a communicable disease. 
Place specimen container inside a clean paper bag 
and clip request to clean side of bag. 

4. Do not send specimens to the laboratory that 
have been spoiled by cigarette butts, matches, 
tissues or other debris. 



Table II -COLLECTION OF SPECIMENS 

CHECK LOCAL STATION ORDERS 



Specimen or test 


Equipment 


Method of collection 


Duty of ward corpsman 


Normal values 




SECRETION OR EXCRETION 










A 


Urine: 












1. Single: 


Urinal or bedpan. 


Patient voids into clean urinal 


Make out request, collect 


Reaction — acid. 




a. Clean. 


Specimen bottle with cap. 


or bedpan. Sample 120-150 


specimen, send specimen 


Specific gravity: 1.012 to 






Rubber band. 


cc. is poured into specimen 


to laboratory. Receive 


1.024. 






Request Form 514a. 


bottle, capped. Request is 


and staple report to Form 


Albumin: negative. 








wrapped around bottle, held 


514. 


Sugar: Negative. 








in place by rubber band. 




Acetone: Negative. 
Microscopic: 

Blood: Negative. 
Pus: Negative. 

Bacteria: Negative. 

Epithelial cells: Few. 




b. Sterile. 


Catheterization tray. 
Sterile specimen bottle. 
Sterile4x4 (2). 
Rubber bands (2). 
Request Form 514a. 


Patient is catheterized per 
doctor's order. Urine is 
collected directly from cath- 
eter into bottle, sterile 4 x 4s 
are placed over top of bottle; 
held in place by rubber 
band. 


Same as 1. 


Same as 1. 




2. 24-hour (quantitative). 


Urinal or bedpan. 


Shipping tag is made out with 


Instruct patient. Collect 


Quantity: 1,000 to 1,800 cc. 






Gallon bottle (from labora- 


patient's name, rate, date, 


specimen for 24 hours 


in 24 hours. 






tory). 


type of specimen; tied to 


(0700-0700) continue as in 


Specific gravity: 1.012 to 






Shipping tag. 


gallon bottle. All urine 


1. Send entire specimen 


1.024. 






Request Form 514a. 


voided is placed in gallon 
bottle. 


to laboratory. 


Sugar: Negative. 
Albumin: Negative. 
Bacteria: Negative. 




3. Guaiac test for blood. 


Normal value: Negative. 


Both tests require same equipment, method of collection as in 






4. Addis' count for cell 


Normal value: 


1 above. 






count. 


RBC: Negative. 

WBC: Negative. 
Casts: Negative. 
Epithelial cells: Few. 


Specify the name of the test and the time of collection on 
Form 514a. 





1 Sources: 

Naval Medical School. Instructions for Requesting Laboratory Services, Bethesda (NNMC) 1949. 

Quill Muller and Dorothy E. Dawes. Introduction to Medical Sciences (2d Ed.) Philadelphia: W. B. Saunders Co. 1948. 

Esther McClain, Scientific Principles in Nursing (St. Louis: C. V. Mosby Co.) 1950. 



2118GG 



-53- 



-14 



19 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Table II —COLLECTION OF SPECIMENS— Continued 



CHECK LOCAL STATION ORDERS 



Specimen or test 


Equipment 


Method of collection 


Duty of ward corpsman 


Normal values 




SECRETION OK EXCRETION— 












Continued 












A. Urine — Continued 












5. Benedict's test for sugar 
(usually done on ward). 


Bedpan or urinal. 


Collect in same manner as for 


May do the entire test or 


Negative. 




Benedict's solution. 


single specimen 20 to 30 


send specimen to labora- 








Alcohol lamp. 


minutes before meals or as 


tory with request as in 1. 








Medicine dropper. 


ordered by doctor. Place 5 


Check "sugar" on Form 








Test tube and holder. 


cc. Benedict's solution in 


614a. 








Matches. 


test tube. Add 8 drops of 
urine to solution. 
Light alcohol lamp. 
Boil solution for 1 minute. 
Note reaction — 
Blue, clear, no change in 

color: Negative. 
Cloudy, slight change in 

color, green: 1 plus. 
Cloudy, yellow green: 2 

plus. 
Cloudy, yellow brown- 




» 


















red: 3 plus. 












Cloudy, orange, brick red: 












4 plus. 








6. Clinitest. Reagent test 


Clinitest reagent tablets No. 


Collect as for single specimen 


May do the entire test. 


Negative. 




for sugar (usually done 


2102. Bedpan or urinal. 


20-30 minutes before meals 


Report and record result. 






on ward). 


Test tube. 
Medicine Dropper. Clinitest 
color chart. 


or asi ordered by doctor. 

Place 5 drops of urine in test 
tube. Rinse dropper then 
add water to the test tube. 
Drop 1 clinitest tablet into 
tube, watch solution boil. 
Wait 15 seconds after boiling 
stops, then shake tube gently. 

Hold tube next to color chart 
and compare. 

All shades of blue: Negative. 

More than 2 percent causes 
rapid change to green, olive 
tan, oranga, brown: Positive. 








Acetest reagent test for Ace- 


Bedpan or urinal. Medicine 


Collect as for single specimen. 


May do entire test. 


Negative. 




tone. 


dropper. Acetest reagent 
tablets. 
Paper towels. 


Place paper towel on table. 
Place tablet on towel. Place 
1 drop of urine on tablet, 
wait 30 seconds, watch color. 

After 30 seconds, no change 
in color or cream shade due 
to wetting. Negative. 

Lavender to deep purple: 
Positive. 


Report and record result. 






B. Feces: 


Clean bedpan. Sputum cup 


Time: Early a. m. before 


Collect specimen. 


Negative. 




1. Ova and Parasites. 


with cover. 


0800. Collect specimen * 


Send specimen to labora- 








2 tongue blades. 


in clean bedpan. Take bed- 


tory. 








Request Form 514g. 


pan to utility room. With 


Receive report: Staple to 








Rubber band. 


tongue blade, remove feces 
from pan; place in cup: fold 
request, name uppermost, 
and place on top of cover. 
Hold request in place with 
rubber band. 


Form 514. 






2. Occult blood. 


Same as Bl, add: Meat-free 
diet. 


Same as Bl. Patient is placed 
on meat-free diet several 
days before specimen is col- 
lected. 


Same as Bl. 


Negative. 




3. Amoeba. 


Clean bedpan. 


Time: Early a. m. if possible. 


Same as Bl. 


Negative. 






2 tongue blades. 


With tongue blades, remove 


Take to laboratory immedi- 








Glass specimen jars (obtain 


feces from pan; place in 


ately, call to technician's 








from laboratory). 


specimen jar. Place jar in 


attention. 








Basin warm water. 


basin of warm water. 










Request Form 514g. 










C. Sputum: 












1. Single. 


Sputum cup with cover. 


Time: Early a. m. before 


Instruct patient, collect and 


Usually taken when 


:uber- 




Request Form 514-E. 


breakfast. Patient rinses 


send specimen with re- 


culosis is suspected. 






Rubber band. 


mouth; coughs deeply, ex- 
pectorates directly into cup. 
Cover cup, fold request, 
on top of cup, hold in place 
with rubber band. 


quest to laboratory. 
Receive report, staple to 
Form 514. 


Negative for AFB. 




2. 24 hour. 


Wide mouth jar with cover 

(obtain from laboratory). 
Form 514-E. 
Rubber band. 


Start and stop at definite time 
(Ex: 0600-0600). All spu- 
tum is expectorated by the 
patient directly into jar. 
Keep jar covered. 


Same as C 1. 


Same as C 1. 





1 Specimen should be at least size of walnut. When specimen is of fluid consistency, glass specimen jar is recommended. 



NURSING AND NURSING PROCEDURES 



199 



Tabic II— COLLECTION OF SPECIMENS— Continued 



CHECK LOCAL STATION ORDERS 



Specimen or test 


Equipment 


Method of collection 


Duty of ward corpsman 


Normal values 


SECRETION OR EXCRETION— 












Continued 










D 


Oastric contents: 












1. Gastric wash (fasting 


Levin tube in basin of cracked 


Time: Early a. m. before 


Explain to patient . 


Usually taken when tuber- 




specimen). 


ice or cold water. 


breakfast. 


Place patient in sitting posi- 


culosis is suspected. 






Lubricant (may be water, 


Levin tube is passed into 


tion. 


Normal: Negative for AFB. 






saline, mineral oil, or lubri- 


stomach. 


Place covered rubber sheet 








cating jelly). 


Syringe is attached to tube. 


over chest. 








Rubber sheet and cover. 


Specimen is withdrawn and 


Assist doctor. Send speci- 








Curved basin. 


placed in specimen tube. 


men with request to lab- 








Sterile: 20 cc. syringe, speci- 


If fluid cannot be aspirated: 


oratory immediately. Re- 








men tube, normal saline so- 


15 cc. saline solution is in- 


ceive report, staple to 








lution. 


jected through tube, speci- 


Form 514. 








Request form 514-E. 


men withdrawn and placed 
in specimen tube. 


Note: Ifspecimenistobe 
collected by ward corpsman : 
See: Gastric intubation. 
Follow instructions in 
"Method of Collection" 
column. 
Where gastric washes are re- 
peated frequently patient 
may be taught to pass 
tube. (On doctor's 
orders.) 






2. Oastric analysis, single 


Levin tube in basin of cracked 


Same as D 1. Omit introduc- 


Same as G 1. 


Fasting specimen. 




fasting specimen. 


ice or cold water. 
Lubricant (may be water, 

saline solution, mineral oil, 

or lubricating jelly. 
Clean test tube. 
Rubber sheet and cover. 
Curved basin. 
Request form 514-F. 


tion of saline. 




Total acidity: 15° to 45°. 
Free hydrochloric acid 5° to 
30°. 




3. Fractional gastric analy- 


Same as D 2. Add 6 test 


Fasting specimen collected as 


Same as D 1 for fasting speci- 


Fasting specimen as above. 




sis. 


tubes in rack from labora- 


in Dl. 


men. 


1 hour after alcohol. Free 




a. Alcohol test meal. 


tory. 


50 cc. 7 percent alcohol is intro- 


Inject 50 cc. 7 percent alcohol 


H CI 20°. Total acidity 






SO cc. syringe. 


duced through tube. 


through tube. 


30° to 80°. 






Label tubes "fasting," Nos. 1, 


Samples of gastric contents 


Collect 15 cc. samples. 








2, 3, 4, 5, 50 cc. alcohol 


are withdrawn at stated 


First, 15 minutes after al- 








7 percent 


intervals. 


cohol. 

Second, 30 minutes after 
alcohol. 

Third, 1 hour after alcohol. 

Fourth, l],i hours after alco- 
hol. 

Fifth, 2 hours after alcohol. 






















Be sure each specimen is 












labeled correctly. 












Take rack of specimens and 












request to laboratory. 












Receive report, staple to 












form 514. 






b. Histamine: This 


Same as above. 


Histamine is given subcutane- 


Collect specimens 15 min- 


30 minutes after histamine- 




test does not always 


Histamine as ordered. 


ously 30 minutes after alco- 


utes after histamine and 


free hydrochloric acid 40° 




follow the alcohol test 


Hypo syringe and needle. 


hol has been injected 


30 minutes after hista- 


to 140°. 




meal. The doctor 


On hand: Syringe containing 


through tube. Samples of 


mine. Label specimens 






writes a specific order 


adrenalin 0.5 cc. 


gastric contents are with- 


with time and ' ' Following 






for histamine to be 




drawn at stated intervals. 


Histamine." Take speci- 






used. 






mens to laboratory. Re- 
ceive report, staple to 
form 514. Watch for reac- 
tion to histamine. Toxic 
reactions: Urticaria, 
headache, sweating, 
drowsiness, dizziness, se- 
vere dyspnea. Antidote: 
Adrenalin. 




E 


Discharge from wounds or 
cavities: 












1. Smear. 


Sterile slides. 


Open package of slides; wrap 


Make out request. 


Negative for organisms. 






Sterile applicator. 


rubber band around the end 


Take smear or assist techni- 








2 rubber bands. 


of 1 slide. With sterile ap- 


cian. 








Request form 514-K. 


plicator take sample of dis- 
charge. Spread discharge 
lightly in center of slide. Re- 
peat for second slide. Place 


Receive report, staple to 
form 514. 








■* 


both slides together, smear 
sides inside. 
Fasten slides together with 
rubber band. Take to lab- 






















oratory with request im- 












mediately. 








200 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Table II.— COLLECTION OF SPECIMENS-Continued 



CHECK LOCAL STATION ORDERS 



Specimen or test 


Equipment 


Method of collection 


Duty of ward corpsman 


Normal values 


SECRETION OR EXCRETION 










E. Discharge from wounds or 










cavities— Continued 










2. Culture. 


Sterile applicators in test 


Remove cotton from tube, 


Make out request. 


Negative for growth. 




tube. 


hold between second and 


Take culture or assist tech- 






Note. — For throat cultures 


third finger. 


nician. 






obtain special tube with spe- 


Remove applicator without 


Receive report, staple to 






cial media from laboratory. 


touching tube. 
With applicator take sample of 

discharge. 
Replace applicator in tube up 

to where it was held by the 

fingers. 
Replace cotton in tube. Take 

to laboratory with request 

immediately. 


form 514. 




F. Blond: 










1. Blood count: 


Request form 514D. 


Skin puncture, usually finger. 


Send request to laboratory. 


RBC. 4,500,000 to 5,000,000 


Red blood count 


Equipment brought by lab- 




Assist technician if neces- 


per cubic millimeter. 


(RBC). 


oratory technician. 




sary. 


WBC. 5,000 to 9,000 per cu- 


White blood count 






Receive report, staple to 


bic millimeter. 


(WBC). 






form 514. 


Differential: 


Differential (DIFF). 








Neutrophils, 66 percent. 


Hemoglobin (HOB). 








Lymphocytes, 26 per- 
cent. 
Monocytes, 6 percent. 
Eosinophils, 2 percent. 
Basophils, 0.5 percent. 


2. Coagulation time. 


Same as Fl. 


Same as Fl. 


Same as Fl. 


Coagulation 3 to 7 min. (Sab- 


Bleeding time. 








row). 
Bleeding 3 to 6 min. (Duke). 


3. Hematocrit. 


Same as Fl. 


Same as Fl. 


Same as Fl. 


Male: 47 cc. per 100 cc. 
Female: 42 cc. per 100 cc. 


4. Sedimentation rate. 


Same as Fl. 


Pour sodium citrate up to first 


May be responsible for com- 


Cutler method: 




May be done by ward corps- 


calibration on cutler tube. 


plete test. 


Males 8 mil. per minute. 




man. 


Withdraw 4 cc. blood by 


Record observations, record 


Females 12 mil. per min. 




10 cc, syringe. 


venipuncture. Mix blood 


calibrations on tube. 






19-gage needle. 


and citrate. 








Tourniquet. 


Place tube in upright position. 








Alcohol sponge. 


Observe tube every 5 min- 








Cutler tube. 


utes for 1 hour: 








Sodium citrate. 


Note the calibration on tube 
as blood separates. 






5. Serological tests: Was- 


Request form 514D. 


Venipuncture: 5 cc. blood is 


Send request. 


Negative. 


serman, Kahn, Kline, 


Equipment brought by labo- 


withdrawn by laboratory 


Assist laboratory technician 




Widal, Other. 


ratory technician. 


technician. 


if necessary. 
Receive report, staple to 
Foim514. 




6. Chemistries: Nonprote- 


Request 514D. 


Venipuncture: Specimen 


Send request. 


NPN 25 to 40 mg. per 100 cc. 


in nitrogen (NPN), urea 


Equipment brought by labo- 


taken by laboratory techni- 


Place "No breakfast" sign 


Urea nitrogen: 10 to 15 mg. 


nitrogen, glucose, uric 


ratory technician. 


cian. 


on bed night before test. 


per 100 cc. 


acid, total cholesterol. 


"No breakfast" sign for pa- 




Withhold breakfast until 


Glucose: 80 to 120 mg. per 


cholesterol ester, total 


tient's bed. 




after blood is drawn, 


100 cc. 


protein, albumin, glob- 






instruct patient. 


Uric acid: 2 to 4 mg. per 


ulin, chlorides as NaCl, 






Receive report, staple to 


100 cc. 


CO2 volume percent. 






form 514. 


Total cholesterol 140 to 230 


calcium, inorganic phos- 






After blood is taken, heat 


mg. per 100 cc. 


phorus, acid phospha- 






and serve breakfast to 


Cholesterol ester: 60 to 80 


tase, creatinine, drug 






patient. 


mg. per 100 cc. 


levels. 




- 




Total protein: 6.8 Om. per 

100 cc. 
Albumin 3.6 to 5.6 Om. per 

100 cc. 
Globulin: 1.3 to 3.2 Om. per 

100 cc. 
Chlorides as NaCl: 450 to 500 

Gm. per 100 cc. 
CO2 volume percent: 55 to 80 

mg. per 100 cc. 
Inorganic phosphorus 3 mg. 

per 100 cc. 
Acid phosphatase: 1.5 to 4 

Bodansky unit. 
Creatinine 0.3 to 0.8 mg. per 

100 cc. 
Drug levels. 


7. Cultures. 


Request form 514K. 
Equipment brought by labo- 
ratory technicians. 


Venipuncture: Specimen is 
taken under strict aseptic 
technique by laboratory 
technicians or doctor. 


Same as Fl. 


Negative. 


8. Typing. 


Request form 514E. 




Same as Fl. 









NURSING AND NURSING PROCEDURES 



201 



Table III.— SPECIAL TESTS AND EXAMINATIONS' 









Diagnostic test 


Equipment 


Method of collection 


Duty of ward corpsman 


A. Body fluids: 








1. Lumbar puncture (spinal 


From CDR: 


Position of patient: Patient is turned 


Assemble and set up equipment. 


fluid). 


Sterile lumbar puncture tray. 


on side near edge of bed, legs 


Tell patient what is to be done. 




Rubber gloves. 


flexed on abdomen, head on chest, 


Place and support patient in proper posi- 




Water manometer 


shoulders and hips in same ver- 


tion. 




Procaine, \i to 1 percent. 


tical plane. 


Assist doctor. 




From ward: 


Method: Doctor paints area with 


Watch condition of patient (color, pulse, 




Alcohol sponges. 


skin disinfectant, anesthetizes lum- 


respiration). 




Curved basin. 


bosacral area, inserts needle into 


Receive and label specimens. 




Cup or jar hold specimens. 


spinal canal, measures the pres- 


After treatment: 




Labels for test tubes. 


sure with manometer, collects 


Caution patient to remain flat in bed 




Skin disinfectant. 


specimens in test tubes. 


for 2 hours or more. 




Chair for doctor. 




Take specimens to laboratory. 




Form 514-h; list all tests ordered 


Normal values 


Receive report, staple to form 514; call 




by doctor. 




to doctor's attention. 






Appearance: Clear, colorless. 


Chart treatment. 






Reaction: Alkaline. 








Specific gravity: 1.001 to 1.010. 








Cell count: to 5. 








Pressure: 70 to 160 mm. water. 








Bacteria: Negative. 




2. Paracentesis (abdominal fluid). 


From CDR: 


Position cf patient: Patient is placed 


Assemble and set up equipment. 




Sterile paracentesis tray. 


in a chair or on side of bed with 


Tell patient what is to be done. 




Rubber gloves. 


feet supported by stool, back sup- 


Place and support patient in proper posi- 




Procaine, \i to 1 percent. 


ported by pillows. 


tion. Drape covered rubber sheet over 




From ward: 


Method: Doctor paints and anes- 


patient's knees. 




Large rubber sheet and cover. 


thetizes abdominal area, makes 


Assist doctor. 




3- to 5-gallon pail. 


incision, inserts trocar, takes speci- 


Watch condition of patient (his color, pulse. 




Technique forceps. 


men, connects tubing to trocar, 


respiration). 




Alcohol sponges. 


fluid drains into pail. 


After treatment: 




Skin disinfectant. 




Allow patient to rest. 




Curved basin. 




Measure fluid. Send specimen to lab- 




Chair for doctor. 




oratory if ordered. 




Stool, extra pillow for patient. 




Receive report, staple to Form 514; 




Form 514m (if specimen is to be 




call to doctor's attention. Chart 




collected). 




treatment. 


3. Thoracentesis (pleural fluid). 


From CDR: 


Position of patient: Sitting on side 


Assemble and set up equipment. 




Sterile thoracentesis tray. 


of bed, feet supported by stool, 


Tell patient what is to be done. 




Rubber gloves. 


back supported by pillows, or 


Place and support patient in proper po- 




Procaine, \b to 1 percent. 


turned on side, with backrest ele- 


sition. 




From ward: 


vated 60°. 


Protect bed with covered rubber sheet. 




Technique forceps. 


Method: Doctor pamts and anes- 


Assist doctor. 




Alcohol sponges. 


thetizes area, inserts needle, at- 


Keep count of amount of fluid as it is with- 




Skin disinfectant. 


taches syringe, aspirates fluid, col- 


drawn. 




Chair for doctor. 


lects specimen. 


Watch condition of patient. (His color, 




Stool, extra pillows for patient. 




pulse, dyspnea). 




Small rubber sheet and cover. 




After treatment: 




Curved basin. 




Allow patient to rest. 




Form 514m for specimen. 




Send specimen to laboratory. 
Measure fluid. 
Chart treatment. 

Receive report, staple to Form 514, call 
to doctor's attention. 


4. Aspiration of fluid from 


From CDR: 


Position of patient: Most comfort- 


Assemble and set up equipment. 


joints. 


Sterile aspirating set. 


able, support joint to be aspirated. 


Support joint to be aspirated. 




Rubber gloves. 


Method: Doctor paints and anes- 


Tell patient what is to be done. 




Procaine, ^ to 1 percent. 


thetizes the aiea, inserts needle. 


Protect bed by covered rubber sheet under 




From ward: 


withdraws fluid, collects speci- 


joint to be aspirated. 




Technique forceps. 


men. 


Assist doctor. 




Alcohol sponges. 




After treatment: 




Small rubber sheet with cover. 




Make patient comfortable. 




Curved basin. 




Provide support for joint. 




Skin disinfectant. 




Give hypnotic if ordered and necessary. 




Form 514m for specimen. 




Take specimen to laboratory. 
Chart treatment. 

Rceeive report, staple to Form 514. 
Call to doctor's attention. 


B. Basal metabolism rate (BMR). 


Special BMR room or on ward in a 


Test is taken by technician. 


Take height, weight, age, record on request 




quiet room or screened area. 


Patient lies quietly in bed. breathes 


form. 




Request form 514m. 


through BMR apparatus. 


Send request to BMR room. 




"No breakfast" sign for patient's 


Respirations are recorded on graph. 


Make appointment. 




bed. 




Tell patient to remain in bed until after test 
in a, m. and to take nothing by mouth 
after 2400. 

Delay a. m. care and breakfast until after 
test. 

Provide transportation to BMR room. 














After treatment: 








Heat and serve breakfast. 








Receive report, staple to Form 514. 
Chart test. 



• Sources: Naval Medical School. Instructions for Requesting Laboratory Servicer, Bethesda (NNMC) 1949. 
Oulli Muller and Dorothy E. Dawes. Introduction to Medical Sciences. (2d Ed. Philadelphia W. B. Saunders Co.) 1948. 



202 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Table III.— SPECIAL TESTS AND EXAMINATIONS-Continued 



Diagnostic test 


Equipment 


Method of collection 


Duty of ward corpsman 


C. Endoscopies: 


Check doctor's orders. 






1. Cystoscopy (I. V.pyelogram). 


For preparation of patient: 


Examination is done in cystoscopy 


Send request, make appointment. 




Enema tray. 


room. 


Preparation of patient: 




Hypnotic if ordered. 


Cystoscope is inserted into urinary 


1. Cleansing enema night before exami- 




"No breakfast" sign for patient's 


bladder, ureteral catheter into 


nation. 




bed. 


fundus of kidney. Dye is given 


2. Give cathartic if ordered. 






I.V. 


3. Omit breakfast on day of examina- 






Pictures are taken. 


tion. 

4. Give hypnotic if ordered. 

5. Provide transportation (stretcher). 

6. Send chart with patient. 
After treatment: 

1 . Heat and serve breakfast. 

2. Force fluids. 








3. Be alert for signs of pain or discom- 
fort. 


2. Bronchoscopy. 


For preparation of patient: 


Examination is done in broncho- 


Send request, make appointment. 




Nothing by mouth. 


scopy room. 


Preparation of patient: 




Hypnotic if ordered. 


Bronchoscope is inserted into trachea 


1. Nothing by mouth 4 to 6 hours 




"Nothing by mouth" sign for 


and large bronchi. 


before examination. 




patient's bed. 


Mucous membrane is visualized. 


2. Give hypnotic if ordered. 

3. Provide transportation (stretcher). 

4. Send chart with patient. 
After treatment: 

1. After anesthetic has worn off, heat 
food and serve to patient. 

2. Be alert for signs of pain or discom- 
fort. 


3. Proctoscopy (follow same 


(Check doctor's orders). 


Examination is done in the procto- 


Send request, make appointment. 


procedure for sigmoidoscopy). 


For preparation of patient: 


scopy room. 


Preparation of patient: 




Enema tray. 


Proctoscope is inserted into rectum, 


A. Evening before examination: 




Hypnotic if ordered. 


mucous membrane is visualized. 


1. Light supper. 




"No breakfast" sign for bed. 




2. Cleansing enema. 




Light supper. 




B. Morning of examination: 

1. Cleansing enema until returns 
are clear. 

2. Omit breakfast. 

3. Give hypnotic if ordered. 

4. Provide transportation (stretch- 
er). 

5. Send chart with patient. 














After treatment: 








1 . Heat and serve breakfast. 








2. Be alert for signs of pain or discom- 








fort. 


D. X-rays: 








1. Bones. , 


Check doctor's orders. 


By X-ray machine in X-ray depart- 


Take height, weight; record on request. 




Bequest Form 519A. 


ment. 


Send request to X-ray. 

Provide transportation if needed. 

Receive report, staple-to Form 519A. 


2. Chest: 


8ame as D 1. 


A. Patient stands against machine, 


Same as D l. 


a. Routine. 




holds breath, picture is taken. 


Be sure female patients are in cotton paja- 


b. K. U. B. 




B. Picture is taken at a 6-foot dis- 
tance. 


mas. 


3. Portable. 


Write "Portable" at top of Form 


Taken on ward by portable machine. 


Send request. 




519A. 




Assist technician as necessary. 
Receive report, staple to Form 519. 


4. Gallbladder series (GB series) 


Request Form 519A. 


X-ray is taken by X-ray department. 


1. Fill out request, add height, weight, age. 


cholecystogram. 


"No breakfast" sign for patient's 


Fatty meal given (usually by X-ray 


2. Make appointment. 




bed. 


department) . 


3. Order fat-free supper from diet kitchen. 




Fat-free supper evening before 


Another X-ray is taken. 


4. Instruct patient— 




X-rays. 




A. To rest as much as possible during 




Gallbladder dye from X-ray. 






afternoon before examination. 
B. To eat or drink only fat-free foods or 
fluids. 

5. Prepare patient: 

A. Evening before — 

(1) Fat-free supper. 

(2) 14 to 1 hour after supper, give 
dye tablet with small amount 
water every 5 minutes until 6 
tablets are taken or as prescribed 
by doctor. 

(3) Place "No breakfast" sign on 
bed. 

B. Day of examination: 

(1) No breakfast. 

(2) Provide transportation. 

6. Receive report, staple to. Form 519. 



NURSING AND NURSING PROCEDURES 



203 



Tabic III.— SPECIAL TESTS AND EXAMINATIONS-Continued 



Diagnostic test 


Equipment 


Method of collection 


Duty of ward corpsman 


D. X-rays — Continued 








5. Gastrointestinal series 


Request Form 519A. 


In X-ray department: Barium is 


1. Fill out request, add height, weight, age. 


(O. I. series): 


"Nothing by mouth" sign for pa- 


given by mouth. 


2. Make appointment. 


a. Upper. 


tient's bed. 




3. Instruct patient to take nothing by 
mouth after 2400 and until told by X-ray 
department. 

4. Provide transportation. 

5. Receive report, staple to Form 519. 


b. Lower (Barium enema). 


Request Form 519A. 


In X-ray department: Barium 


1. Fill out request and make appointment 




Enema tray. 


enema is given, intestinal tract is 


as in 5DA. 






visualized. 


2. Prepare patient: 

A. Cleansing enema evening before 
and morning of examination. 

B. May have light breakfast of 
coffee and toast. 

3. Provide transportation. 

4. Receive report, staple to Form 519. 
After examination (A and B): 

1. Give food when instructed by X-ray 
department. 

2. Patient may need enema to remove 
barium (doctor's order). 


E. Electrical impulses: 








1. Electrocardiograph (ECQ) 


Special ECO room or bed in ward. 


Patient lies quietly in bed. 


Take height, weight, age; record on re- 


(EKO). 


Request Form 520. 


Leads are fastened to various parts 


quest. 






of body. 


Send request, make appointment. 






Electrical impulses are recorded on 


On ward: 






graph. 


Tell patient to remain quiet. 
Fold top covers to foot of bed. 
Loosen pajama coat- 
Assist technician if necessary. 
In ECO room: Provide transportation to 
room. 


2. Electroencephalogram 


Special EECG room. 


Leads are fastened to various parts 


Send request to EECG room, make ap- 


(EECQ). 


Request Form. 


of head. 


pointment. 






Electrical impulses are recorded on 


Provide transportation. 






graph. 


Receive report, place on chart. 



204 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



ADMINISTRATION OF MEDICINES 
Review — Applicable Sections in Chapter VII; Materia Medica and Pharmacology 

Chapter VIM, Pharmacy 



Medicines are usually ordered by the doctor for 
one or all of the following reasons : 

1. To promote the patient's health (example: 
vitamins) . 

2. To cure the patient's disease (example: 
antibiotics) . 

3. To relieve patient's pain or discomfort (ex- 
ample : narcotics) . 

The administration of medicines is one of the 
most responsible duties of the corpsman. In the 
administration of medicines the corpsman is ex- 
pected to : 

1. Carry out the doctor's order accurately, 
giving the right dose of the right medicine to the 
right patient at the right time and in the right 
way. 

2. To observe, record, and report the effects of 
the medicine on the patient. 



Suggested Routine for Administration 
Medications and Treatments 



of 



Purpose: To provide an orderly, safe and eco- 
nomical method of administering medications and 
treatments. 

Equipment 

Medication and treatment board. 

Medication and/or treatment cards. 

The board provides a visible file for all medica- 
tions and treatments to be given over a 24-hour 
period. This board may be placed on the inside 
door of the supply closet next to the medicine 
locker, in the space between the upper and lower 
cabinets of the locker, or on the wall to the side of 
the medicine locker. The board may be made to fit 
the spaces available. All boards should provide : 

1. Space for 25 hooks ( 1 for each hour and prn) . 

2. Space between hooks sufficient to allow use of 
iy 2 - by 3-inch cards. 

3. Instructions on the use of board. 



Medication and/or Treatment Cards 

Cards are made out for medications and treat- 
ments : 

1. Ordered for repeated doses at specified times. 

2. Ordered prn. (Specify frequency at which 
dose or treatment may be safely repeated.) 



MEDICATION 

0100 0200 0300 



0600 0900 1000 



1500 1600 1700 

Q D 

2200 2500 2400 




AND T 

0400 1 



1100 



1800 
1 

PRN 












REATMENT 

)500 0600 0700 






O 


BED NO. DATE 


200 1300 




1400 
+1 


NAME 






MEDICATION 


— 


M 


^— 


DOSE 


900 2000 

n n 




2100 


U U u 


HOURS 


INSTRUCTIONS 











14 Adapted from Questionnaire "Administration of Medicines." 
Naval Hospitals, 1951. 



Figure 231. — Medication and Treatment Board and Card. 

Cards (IV2- by 3-inch) may be cut from white 
file cards. 

Cards should include all necessary informa- 
tion — patient's name, bed number, medication or 
treatment, hours to be given, discontinue date if 
one is specified. (Check station orders for addi- 
tional information desired on cards.) 

Cards must be checked with doctor's order 
sheets at least twice daily — new cards made out 
for new orders, cards destroyed for discontinued 
orders. (New order for narcotics should be ob- 
tained from the doctor after 21 hours.) 

Use of Board and Cards 

1. Card is placed on the hook corresponding 
to the hour the medication or treatment is due. 

2. When due, the card is removed, medication 
or treatment is given, and the card replaced on the 
hook for the hour when it is next due. 



NURSING AND NURSING PROCEDURES 



205 



3. The medication or treatment is checked off 
in the nursing notes of the patient's chart after 
it has been given. 

4. Card of prn order is placed on hook corre- 
sponding to the hour at which it may be safely 
repeated. 

5. Card of daily order is placed face down on 
the same hook after it has been given. 

Rules for Administration of Medication 
Do 

1. Do have order for medicine signed by the 
doctor. 

2. Do know how to give the drug in the manner 
prescribed by the doctor. 

3. Do wash your hands before preparing the 
medicine. 

4. Do measure all dosages at eye level, whether 
in a glass or syringe. 

5. Do prepare the medicine you give and give 
the medicine you prepare. 

6. Do have a good light when preparing 
medicine. 

7. Do concentrate. 

8. Do know how drugs act; whether a local or 
systemic effect is desired and what possible bad 
effects might occur. 

9. Do know the minimal, average, and maximal 
dosage of the drugs you give. 

10. Do read the label three times when prepar- 
ing a medicine — 

a. "When removing it from shelf or drawer 

b. After pouring or preparing it 

c. When returning it to the shelf or drawer 

11. Do give minims when minims are ordered, 
drops when drops are ordered. 

12. Do use surgical aseptic technique in prepar- 
ing injections and when indicated for installations 
and irrigations. 

13. Do chart medications after you have given 
them. 

14. Do chart the name and amount of medica- 
tion and the time it was given. 

Do not 

1. Do not give a medicine without an order. 

2. Do not allow interruptions while preparing 
medications. 



3. Do not give when doubt exists concerning 
the patient, the drug or the dose. Consult your 
doctor or nurse in charge of the ward. 

4. Do not use a medicine from an unmarked 
or poorly labeled bottle or container. 

5. Do not return excess medicine to the stock 
bottle or box : discard into sink. 

MEDICATION BY MOUTH 

Administration 

1. Acids and irons are given well diluted 
through a drinking tube. 

2. Irons, iodides, and arsenic preparations are 
usually given after meals. 

3. Cough medicines are given last, undiluted; 
instruct patient not to drink any fluids for at least 
15 minutes afterward. 

4. Shake liquids well before pouring. 

5. Dilute liquids with i^-ounce of water unless 
contraindicated. 

6. Give saline medications for edema in small 
amount of water; saline cathartics in large 
amounts of water. 

7. Make disagreeable medicines as palatable 
as possible. 

a. Castor oil mixed with orange juice and 15 
grains sodium bicarbonate. 

b. Add small amount of lemon juice to saline 
cathartics. 

c. Chill mineral oil, follow with slice of orange. 

8. For young children or elderly patients, crush 
pill or tablet and dissolve in small amount of 
water ; use teaspoon instead of medicine glass. 

Equipment 

CRM instrument tray with: 
Medicine glasses for liquids 
Souffle or paper cup for pills or tablets 
Stirring rod 
Medicine cards 
Pitcher of water 
Medicine dropper 
Paper straws or drinking tubes 
Teaspoon 
Paper wipes 

Procedure 

Preparation of Medicines. 
Wash your hands! 



V 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 232. — Equipment for Administration of Medicine by Mouth. 

1. Unlock cabinet. Remove cards from board. 

2. Arrange cards in sequence similar to place- 
ment of patients on ward. Stack cards so that 
one card is visible at one time. 

3. Take first card : Locate and remove medicine 
from shelf. 

4. Read label : Compare label with card, place 
card on tray. 

5. Obtain medicine glass, read label : Place 
medicine in glass, place glass on card in tray. 

Pill, tablet, capsule 

If in bottle, pour required number into lid of 
bottle. 
If in box, remove required number with spoon. 




Figure 233. — Removing Tablet from Bottle. 

Powder 

If in paper — empty into medicine glass, add 
water, stir with stirring rod. 

If measured with spoon, empty into medicine 
glass; add water, stir with stirring rod. 



Liquid 

Shake bottle. 

Remove cap, place it inside up on shelf. 

Hold medicine glass in left hand so that mark 
of prescribed amount is at eye level. Place thumb- 
nail at mark. 




Figure 234. — Pouring Liquid Medication. 

Hold bottle in right hand ; label next to palm ; 
pour designated amount. 

Wipe rim of bottle with paper wipe ; replace cap. 

Dilute medicine with one-half ounce of water 
unless contraindicated. 

Drops 

Use medicine dropper. 

Draw up approximate amount of drug from 
bottle. 

Holding dropper at 45° angle, count prescribed 
number of drops into medicine glass. 




Figure 235. — Correct Angle of Medicine Dropper. 

Discard solution remaining in dropper into sink. 
Dilute medicine with one-half ounce of water. 

Minims 

Use minim glass. 

Follow same procedure as for pouring liquids. 

6. Read label: check medicine card with label 
on bottle: replace bottle on shelf. 

7. Repeat step 5 for remaining cards. 



NURSING AND NURSING PROCEDURES 



207 



Administration of Medicines 

1. Carry tray to ward. 

2. Identify patient. 

a. Read bedtag. 

b. Check tag with medicine card. 

c. Ask patient his name ; compare with card. 

3. Give medicine in glass to patient. 

4. Give water with medicine unless contraindi- 
cated. 

5. Stay with patient until medication has been 
taken ; do not leave medication at bedside. 

6. Place medicine glass to one side of tray; 
turn medicine card face down on tray. 

7. Repeat steps 2 through 6 for remaining 
medications. 

After Care 

1. Wash all glasses with hot soapy water; rinse. 
Boil glasses for 10 minutes. 

2. Wash spoons, droppers, pitchers and tray. 

3. Reset tray. 

4. Chart medications. Return cards to board 
in correct order. 

A wheeled cart may be used in place of tray ; the 
set up and manner of administration remains the 
same. 

Medication by Sublingual Route (Under 
the Tongue) 

Medicine is in quickly dissolving pill form. The 
pill is placed under the patient's tongue and 
allowed to dissolve. No water is given. 

Medication by Injection 

Purpose: To produce rapid systemic effect; to 
produce local reaction ; to administer drug which 
is destroyed by gastric juices or when drug can- 
not be taken by mouth. 

Method of injection 

Intradermal — into the superficial layers of the 
skin. Used to test for specific allergic reactions. 

Subcutaneous. — under the skin. Used pri- 
marily to administer narcotics, sedatives. 

Intramuscular — into the muscle. Used when 
drugs are not suitable for intravenous injection, 
when a more rapid effect is desired than could be 
obtained by subcutaneous method, when drug is 
not readily absorbed, or when it is irritating to 
subcutaneous tissue. 



SYRINGES FOR INJECTION 

Alt syringes mutt be sterile ; be of correct size for the medicotion to bt 
administered and be handled with oseptic technique 



20 40 60 80 



TUBERCULIN SYRINGE 
I ee. copocity— scaled in l/lOO of a cc. 
Used for very small dosage when fractions of 
cc- or small number of minims ore desired 



GSQ 



10 20 30 *0 50 60 TO 80 UNITS 



♦ 371 



INSULIN SYRINGE 

I cc. capacity — scaled in units per cc 

Used for administration of insulin 



1^ I £ 2 cc 

IHllllllllllllllIll 



2 CC. SYRING 
2 cc. capacity— seated in minims and 1/2 cc. 
Used for injections of less than 2 cc. 




10 CC. SYRINGE 
10 cc. capacity — scaled in 2^0 ec. 
Used for injections of 5-10 cc. dosage 



c< 


II 


III 


lll|ll 


II II 


||| 




1941 


A 




5 


10 


15 


20 


CC 





1( pH] 



20 CC. SYRINGE 

20 cc. capacity — scaled in cc. 

Used for injections 10-20 cc. dosage 

30 OC. SYRINGE — Scaled in ec. 
SO CC. SYRINGE — Used for injections 20-50 cc dosage 
(Not shown) 

Figure 236. — Syringes for Injection. 

Intravenous — into the vein. Used when very 
rapid effects are desired. 

Intraspinous — into spinal canal. Used pri- 
marily for producing anesthesia. 

NEEDLES FOR INJECTION 



Intradermal — 25 gauge > 1/2 inch length 



Subcutaneous — 23 gauge < 3/4 inch length 



Intramuscular — For deltoid-23 x 3/4 inch length 
For buttock- 2 1 1 1)4 inch length 



Intravenous — 21 (I or 19 1 2 inch length 



Intraspinous — lumbor puncture needle 
Figure 237. — Needles for Injection. 



208 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



The use of autoclaved syringes and needles 
is required for intravenous and intraspinous in- 
jections and is strongly recommended for all 
injections. When autoclaved equipment is not 
available : 

1. Boil syringe and needle for 10 minutes in 
sterilizer just before preparing medications. 

2. When a number of injections must be pre- 
pared, set up tray for injections using syringes 
and needles directly from the sterilizer. 

3. Maintain a hypodermic tray with sterile 
syringes and needles in a covered container of 
TO percent alcohol or Benzalkonium chloride 
1 : 1000 solution. 15 

Subcutaneous Injection 

Equipment 

Metal tray with: 

Sterile covered tray of 70 percent alcohol 

containing 2 cc. syringes, needles, 23gx%", 
^21g X li/ 4 ",25gxi/ 2 ". 

Sterile covered container of alcohol sponges. 
Thumb forceps in container three-fourths 

filled with alcohol 70 percent. 
Rubber-stoppered vial of sterile distilled 

water. 
Screw-capped bottle of distilled water. 
Sputum cup without cover for waste. 
Matches. 




Figure 238. — Hypodermic Tray. 



15 Tests on dry sterile syringe container showed growth in 5 
hours of use. Tests on sterile syringes in container of 70 percent 
alcohol showed no growth in 24 hours of use. Refer to station 
-orders for local requirements. 



Ampoul file. 
Alcohol lamp. 

Precautions 

1. Use sterile technique in the preparation and 
administration of injections. 

2. Rinse alcohol from syringe with sterile water 
before preparing medication. 

3. Match numbers of syringe barrel and plunger. 

4. Test needle for hooks and burrs before taking 
medication to patient. 

5. Use a separate syringe for each injection. 
Procedure 

Preparation of syringe and needle 

1. Using forceps, remove alcohol sponge from 
container; place sponge on top of distilled water 
vial. 

2a. Using forceps ; remove syringe barrel from 
container. 

b. Check number on barrel; using forceps, 
pick up plunger having the same number ; insert 
it into barrel. 

c. Using forceps; pick up needle and attach 
it to the syringe. 

3. With fingers, tighten the needle on the 
sja'inge. 

4. Wipe top of vial with alcohol sponge; dis- 
card sponge. 

5. Push plunger back and forth to expel alcohol. 

6. Remove 1 cc. of water from vial. 

la. Rinse syringe by pushing plunger back and 
forth. 

b. Discard water into sink. ■ 
Preparation of solution (fig. 239) 

1. Using tablets not readily dissolved. (Ex- 
ample: codeine, pantopon). 

Pour distilled water into spoon of alcohol lamp. 
Boil water 1 minute ; cap lamp. 

Assemble syringe and needle. 

Draw desired amount of water into syringe; 
discard remainder from spoon. 

Drop tablet into spoon ; eject water from syringe 
over tablet until dissolved and solution is clear. 

Draw all solution into syringe. 

Cover needle with alcohol sponge; check point 
for hooks and burrs. 

Take to patient. 



NURSING AND NURSING PROCEDURES 



209 



PREPARATION OF MEDICINES FOR NEEDLE (PARENTERAL) INJECTIONS 



MEDICINE FROM STOPPERED VIAL 




1. Cleanse stopper with alco- 
hol sponge. 

2. Assemble syringe and 
needle. 

3. Draw back plunger of 
syringe to the amount of 
solution desired. 

4. Insert needle through cen- 
ter of stopper, push in 
plunger. 

5. Invert vial ; pull back on 
plunger, withdraw desired 
amount ; remove needle. 

6. Cover needle with alcohol 
sponge ; check point for 
burrs and hooks. 

7. Take to patient. 



MEDICINE FROM AMPOUL 




1. Wipe file and neck of ampoul with al- 
cohol sponge. 

2. File neck of ampoul. 

3. Cover ampoul with alcohol sponge. 

4. Break off neck of ampoul at tile marks. 




1. Assemble syringe and needle. 

2. Tip ampoul to 45° angle. 

3. Insert needle into ampoul, withdraw 
desired amount of solution. 

4. Cover needle with alcohol sponge ; 
check point for burrs and hooks. 

5. Take to patient. 



MEDICINE IN TABLET FORM 

1. Pour distilled water into spoon of 
alcohol lamp. 

2. Boil water one minute : cap lamp. 

3. Assemble syringe and needle. 

4. Draw desired amount of water into 
syringe ; discard remainder from 
spoon. 

5. Drop tablet into spoon : eject water 
from syringe over tablet until dis- 
solved and solution is clear. 

6. Draw all solution into syringe. 

7. Cover needle with alcohol sponge ; 
check point for burrs and hooks. 

8. Take to patient. 




Fractional dosage 

1. Work out problem on paper. 

2. Follow steps 1 through above. 

3. Discard the necessary amount of solu- 
tion as shown by answer to problem. 

4. Follow steps 7 and 8 above. 



INTRADERMAL 



ADMINISTRATION OF PARENTERAL MEDICINES 
SUBCUTANEOUS 





1. Explain to patient. 

2. Swab site of injection with an alcohol 
sponge. 

3. Hold syringe upright, expel air bub- 
bles. 

4. Insert needle at a 15° angle, just 
under the skin, so that a raised area 
is seen. 

5. Inject prescribed amount of solution. 

6. Cover needle with alcohol sponge, 
withdraw needle. 




1. Explain to patient. 

2. Swab site of injection with an alcohol 
sponge. 

3. Hold syringe upright ; expel air bub- 
bles. 

4. Make a firm cushion of flesh at In- 
jection site. 

5. Insert needle quickly at a 45° angle. 

6. Draw back on plunger; if resistance is 
felt and no blood seen, slowly inject 
solution. 

7. Place alcohol sponge over needle : 
quickly remove needle. 

8. Gently massage site of injection with 
alcohol sponge for one minute. 



INTRAMUSCULAR 



90° 




1. Explain to patient. 
L'. Swab site of injection with an alcohol 
sponge. 

3. Hold syringe upright; expel air bub- 
bles. 

4. Make a firm cushion of flesh at in- 
jection site. 

5. Insert needle quickly at a 90° angle 
0. Draw back on plunger ; if resistance is 

felt and no blood seen, slowly inject 
solution. 

7. Place alcohol sponge over needle ; 
quickly remove needle. 

8. Gently massage site of injection with 
alcohol sponge for one minute. 



Figure 239. — Preparation and Administration of Medicine for Parenteral Injection. 



210 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



2. Using tablets readily dissolved. 

Kemove 1 cc. of sterile water from vial. 

Cover needle with alcohol sponge. 

Remove plunger. 

Drop tablet into barrel. 

Holding barrel at 45° angle, gently insert 
plunger, avoid dispelling water. 

With needle covered by sponge and plunger 
secured by fingertip, gently agitate syringe until 
tablet is dissolved and solution is clear. 
Administration of injection (fig. 239) 

1. Explain procedure to patient. 

2. Swab site of injection with alcohol sponge. 

3. Hold syringe upright; expel air bubbles. 

4. Stretch skin taut between thumb and fore- 
finger of left hand, grasp arm firmly at either 
side of site of injection, lifting up tissue to form a 
cushion. 

5. Insert needle quickly at a 45° angle (fig. 239) . 

6. Draw back on plunger; if resistance is felt 
and blood is not seen, slowly inject solution. 

7. Place alcohol sponge over needle; quickly 
remove needle. 

8. Gently massage site of injection with an 
alcohol sponge for one minute. 

After care of equipment 

1. Rinse syringe and needle with cool water. 

2. If autoclaved equipment was used, send 
cleansed syringe, needle and wrapper to CDR. 

3. Equipment from hypodermic tray: 

a. Separate barrel, plunger, and needle. 

b. Place in sterilizer; boil 10 minutes. 

e. Return boiled syringe and needle to sterile 
container. 

4. Discard waste ; reset tray. 

Daily 

1. Strip entire tray; filter alcohol. 

2. Wash and boil containers, syringes, needles. 

3. Reset tray ; refill containers with alcohol. 

Fractional dosage 

1. Work out the problem on paper using the 
formula : 

(quantity of wa- 
ter in minims in 
which tablet (s) 
are to be dis- 
solved 



) 



dose to be 

given in 

minims. 



Example : 

If the dose on hand is larger than the dose 
desired : 
Dose desired : Morphine sulfate y$ grain. 
Dose on hand : Morphine sulfate y± grain. 



y 4 



X quantity = dose 

% x 4 A x 24M= 16 minims 

Answer: Dissolve one (!/4 grain) tablet of mor- 
phine sulfate in 24 minims of water. Discard 8 
minims — give 16 minims to patient. 

Example : 

If the dose on hand is less than the dose desired 
it will be necessary to use two or more tablets. 

Dose desired: Morphine sulfate % grain. 

Dose on hand : Morphine sulfate % grain. 

Theref ore it will be necessary to use 2 tablets. 

1/6 X24 



y 8 X2 
% = 1 A 



y 6 X%X24 =16 minims 



Answer: Dissolve two (y 8 grain) tablets of mor- 
phine sulfate in 24 minims of water; discard 8 
minims, give 16 minims to patient. 

INTRAMUSCULAR 

Prepare solution and administer medication as 
illustrated in figure 239. 

INTRAVENOUS 16 

1. Prepare solution as required by packaging. 
Use 19-gage, 2-inch needle. 

2. Take prepared syringe and tourniquet to 
patient. 

3 Select site of injection; place tourniquet 
under arm above site. 

4. Tighten tourniquet ; doctor will insert needle. 

5. When blood appears in the syringe, loosen 
tourniquet. 

6. Doctor will inject solution. 

7. Place alcohol sponge over needle; doctor 
removes needle. 

8. Flex patient's arm ; hold alcohol sponge over 
site for a few seconds. 



16 Corpsman is not responsible for intravenous injections of 
medicine. If in an emergency he is required to do so, the angle 
of injection is the same as illustrated under venipuncture illus- 
tration in laboratory section (Plate XI). Strict aseptic 
technique must be used. 



NURSING AND NURSING PROCEDURES 



211 



INTRASPINAL 

Procedure 

1. The preparation of equipment and patient is 
same as for lumbar puncture. (See p. 201.) 

2. Preparation of solution depends upon pack- 
aging; follow instruction as applicable. 



Antibiotics 

1. Use autoclaved or boiled syringes and needles 
whenever possible. 

2. If syringe has been in alcohol, rinse thor- 
oughly with sterile distilled water before taking 
up an antibiotic. Alcohol destroys the effective- 
ness of the antibiotic. 



SPECIAL MEDICINES FOR INJECTION 

INSULIN — types of insulin 

Regular or standard insulin is available on the 
supply table in 10 cc. vials of two strengths; 20 
units in each cc. ; 40 units in each cc. 

Protamine zinc insulin is available in 10 cc. 
vials of 40 units in each cc. 

Preparation of insulin — both types 

1. Use a dry, sterile insulin syringe. 

2. Use the measure on the syringe corresponding 
to the strength of the insulin. Example: Regu- 
lar insulin U35 has been ordered: 

Locate the U40 scale on the syringe. 
Obtain U40 per cc. strength insulin. 
Withdraw insulin from the vial down to the 
U35 mark on the U40 scale of the syringe. 

3. Regular insulin should be clear and colorless. 

4. Protamine zinc insulin is in suspension and 
the vial must be rotated before use. 

Administration 

1. Insulin is given subcutaneously in the same 
manner as other hypodermics. 

2. Change the site of injection each time a dose 
is given. Use both upper arms and anterior 
thighs in rotation. 

3. Give the insulin at the correct angle of injec- 
tion. Avoid too deep or too shallow injections. 

4. Time of administration 

a. Regular insulin — 20 minutes before meals. 

b. Protamine zinc — once daily. 
Precaution: When both types are ordered to 

be administered at the same time, use a separate 
syringe for each type. 

Medicines in oil 

1. Warm solution in water bath. 

2. Use a large bore needle (18g) to remove 
solution from the ampule or vial. 

3. Give medication as an intramuscular injec- 
tion into the buttocks. 



MEDICATION BY INHALATION 

May be in the form of gases or volatile drugs 
and are given for their local or systemic effect. 

Steam inhalation 

Purpose: To provide moist heat and relieve 
congestion in upper respiratory passages. 

Method I 
Equipment 

Vaporizer 

Medication if ordered 
Water 
Bath towel 

Precautions 

1. Prevent burning the patient. Keep vapor- 
izer 12 to 18 inches away from patient. 




Figure 240. — Steam Inhalation. Croup tent may be made by 
draping blanket over two irrigating stands. 



21 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



2. Do not wash vaporizer under running water; 
the electrical element must be kept dry. 

Procedure 

In utility room: 

1. Fill vaporizer to water level mark. 

2. Place medication as directed in instructions 
on vaporizer. 

3. Plug in vaporizer ; allow water to boil. Take 
to bedside. 

At bedside: 

1. Bring patient to side of bed. 

2. Place bath towel around patient's head. 

3. Plug in vaporizer; turn spout so that steam 
is directed toward the patient. 

4. Ask the patient to open his mouth and take 
deep breaths. 

5. Treatment should last about twenty minutes. 

After treatment: 

1. Dry patient's face. 

2. Prevent patient's being chilled. Caution him 
to stay inside ward until at least one-half hour 
after treatment. 

Method II 
Equipment 

Wash basin 
Pitcher 
Paper bag 
Bath towel 
Towel 
Medication 
Boiling water 

Precaution: Patient must not touch pitcher; 
ask him to keep his hands at his side. 

Procedure 

1. Place pitcher in basin. 

2. Cut hole in bottom of paper bag to fit over the 
mouth and nose of the patient. 

3. Pour boiling water into pitcher. 

4. Take to bedside. 

5. Have patient place his mouth and nose over 
hole in paper bag. 

6. Drape bath towel over patient's head and over 
the pitcher. 




Figure 241. — Steam Inhalation by Pitcher Method. 

7. Ask patient to open his mouth and take deep 
breaths. 

See "Administration of oxygen and other 
gases" for other methods of mediciation by 
inhalation. 

MEDICATION BY RECTUM 

Medications may be administered by means of 
retention enemas or suppositories. 

Purpose : To produce a local or systemic effect. 

Indicated : In presence of nausea or vomiting ; 
when administration by mouth is impossible ; when 
drug is unpalatable. 

Retention enema : 

Total quantity of fluid should not exceed 120 cc. 

Irritating drugs such as paraldehyde and so- 
dium salicylate are best given in a thin solution of 
corn starch. See procedure for retention enema 
(pp. 239-240). 

Suppository 

Drug is mixed with a solid which melts at body 
temperature. 

Equipment 

1. Prescribed suppository. 

2. Finger cot or rubber glove. 

3. Lubricant. 

4. Toilet tissue. 

Take equipment to bedside in curved basin. 



NURSING AND NURSING PROCEDURES 



213 



Procedure 

1. Screen patient ; ask or assist him to turn on 
his side. 

2. Expose rectum. 

3. Put on glove or finger cot (index finger). 

4. Lubricate glove. 

5. Introduce suppository gently into rectum and 
advance it as far as possible. If patient has diffi- 
culty retaining suppository, apply pressure over 
rectum until the desire to defecate has passed. 

6. Remove glove; place in curved basin. 

In utility room 

Wash and boil basin and glove. 
Discard finger cot. 

LOCAL APPLICATIONS OF MEDICATIONS 

Medications may be applied locally in the form 
of lotion, ointment, or paste. 



Lotion — Equipment 

1. Shallow dish. 

2. Cotton pledgets. 

3. Prescribed lotion. 

Procedure 

1. Pour lotion into shallow dish. 

2. Apply lotion to area, using cotton. 

Ointment and paste — Equipment 

1. Prescribed ointment or paste. 

2. Tongue blade or spatula. 

3. Gauze or soft muslin. 

4. Bandage or binder. 

Procedure 

1. With tongue blade, remove ointment from 
container. 

2. Spread a thin layer of ointment on gauze. 

3. Apply coated gauze to area. 

4. Secure with bandage or binder. 

Note. — When applied to wound, sterile articles must be 
used and aseptic technique maintained. 



ADMINISTRATION OF OXYGEN AND OTHER GASES 

Review — Chapter II, "The Respiratory System" 

Chapter VI, "Safety" 



THE ADMINISTRATION OF OXYGEN 17 

Purpose: To make an extra supply of oxygen 
available to the patient. 

Indicated: In conditions of anoxia (lack of 
oxygen) and anoxemia (lack of oxygen in blood). 
Some symptoms of anoxia are cyanosis and dysp- 
nea, rapid thready pulse and restlessness. Ox- 
ygen is used as a supportive measure for patients 
with pneumonia, asthma, cardiac failure, decom- 
pensation, thrombosis, and shock; and is some- 
times used for postoperative patients. 

SAFETY RULES IN USE OF OXYGEN 

In storerooms 
Oxygen Cylinders 

1. Keep cylinders secured (strap, chain) in 
upright position in a separate place away from 



17 Adapted from Oxygen Therapy Handbook. Linde Air Prod- 
ucts Co., 1943. New York. 



oil, grease, gasoline, matches, alcohol, ether; 
from heating equipment, boilers, furnaces, 
radiators, steam pipes, sterilizers, autoclaves. 

2. Have storage space well posted with 
"Oxygen — No Smoking'' signs. 

3. Keep caps on all cylinders. 

4. Have separate and clearly marked place for 
storing full and empty cylinders. 

5. When removing cylinder from storeroom, 
remove cap, open and close valve quickly. This 
is called ''cracking*' the valve. Eeplace cap. 





Figure 242. — Cracking the Valve. 



211866°— 53- 



-15 



214 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Regulators 

1. Store in closed cabinets. 

2. Label all regulators with tags "Do Not Oil 
or Grease." 

3. Test regulators frequently for leaks and 
liter flow accuracy. 

4. Do not attempt to repair regulators; return 
regulators to issue room. 









\i 






iifi j*+ 

HI;! S^— 


H 




I Si 'i 


r-P 


'ft ) — ^-' s ^ 

<S> -fe 



Figure 244. — Types of Regulators. 

Oxygen tent motors 

1. Store in cool, clean dry rooms. 

2. Use muslin dust covers (may be made in the 
sewing rooms) to keep motors clean. 

3. Set up and test motor operation at regu- 
lar intervals every 2-3 weeks. 

On ward 

1. Post "Oxygen — No Smoking'' signs at the 
entrance to the ward, room or unit. 

2. Strap oxygen cylinder to bedpost or to car- 
rier to keep it in an upright position. Cylinder 
should be placed away from radiators. 

3. Instruct all patients and visitors not to 
smoke within the area. 

4. Always have an extra cylinder of oxygen 
on hand to assure patient a continuous supply. 
Watch usage rate of oxygen. 



Table IV.— APPROXIMATE REMAINING 
HOURS OF SERVICE IN STANDARD 244- 
CUBIC FOOT AND 220-CUBJC FOOT CYL- 
INDERS OF U. S. P. OXYGEN x 

Examples: Full cylinder, at 2,200-pound pressure, flow- 
ing at rate of 6 liters should last approximately 19 hours. 
A cylinder with 1,000-pound pressure flowing at a rate of 
8 liters per minute should last 6 hours. 



Rate of flow 

in liters per 

minute 


244 cubic 

feet; 2,200 

pounds; 

6,900 liters 


220 cubic 

feet; 2,000 

pounds; 

6,200 liters 


165 cubic 
feet; 1,500 
pounds; 

4,650 liters 


110 cubic 

feet; 1,000 

pounds; 

3,100 liters 


55 cubic 

feet; 500 

pounds; 

1,550 liters 


1 


[[ours 
28 
19 
14 
11 

9 

8 

7 


[[ours 
25 
17 
12 
10 

8 

7 

6 


[[ours 
19 
12 
9 

7 
6 
5 
4 


Hours 
12 
8 
6 
5 
4 
3 
3 


[[outs 
6 


6 


4 


8-._ 


3 


10__. 


2 


12 


2 


14 


1 


16 


1 







1 Ohio Chemical & Surgical Equipment Co., 1400 East Washington Ave., 
Madison, Wis. 

5. When an oxygen tent is in operation : 

Do not use electrical devices (call bells, 
heating pads, vaporizers) inside tent. 

Do not use alcohol or ether inside tent. 

Keep patient clothed in cotton material; 
wool and nylon are dangerous because of their 
static electrical properties. 

6. Mark cylinders before returning them to 
storeroom. When empty : 

Remove regulator. 
Close valve; replace cap. 
Label cylinder "empty." Use shipping tag 
or jiiece of adhesive tape. 




Figure 246. — A. B. C. D. Attaching Regulator to Cylinder. 



NURSING AND NURSING PROCEDURES 



215 



7. To attach regulator to cylinder: 

Remove cylinder valve cap. Insert regula- 
tor inlet into cylinder valve outlet and tighten 
inlet nut with wrench (fig. 246a). 

Important! Before opening (fig. 246b) 
cylinder valve, always loosen regulator flow 
adjusting knob. 

Open cylinder vajve slowly until needle of 
cylinder gage stops moving (fig. 246c). 

Turn flow adjusting knob until desired rate 
of flow shows on flow indicator gage (fig. 
246d). 



Nasal Catheter Method 
Equipment 

Oxygen cylinder flow gage (regulator), hu- 
midifier. 

Lubricant and tissue. 

Four feet of rubber tubing. 

Catheter (8-14 French) with extra holes as near 
tip as possible. 




Figure 247. — A. B. C. Disconnecting Regulator and Cylinder. 

8. To disconnect regulator, cylinder : 
Close valve tightly, (fig. 247a) 
Wait until both cylinder and flow gages 

have registered zero. (fig. 247b) 
Loosen flow adjusting knob. Unscrew inlet 

nut. Remove regulator. Recap cylinder. 

(fig. 247c) 

Methods of Administration 

The method of administrating oxygen is se- 
lected by the doctor. He may order oxygen to be 
given through a nasal catheter, by face mask, or 
by the tent method. 

Mental preparation of patient for all meth- 
ods. — The patient is able to obtain maximum bene- 
fit from oxygen only when any fear, anxiety or 
suspicion existing in patient's mind is relieved. 
Explain, reassure, and demonstrate what is to be 
clone, how it will relieve him, and what he must 
do to set the best results. 



Figure 248. — Equipment for Naval Catheter Method. 

Connector (from tubing to catheter). 

Rubber band and safety pin. 

Wrench. 

Glass of water. 

Adhesive — 1 small piece to mark catheter. Two 
6-inch strips of one-half inch width split half way 
down. 

Procedure 
Preparation of equipment in utility room 

1. ( )pen and close valve of oxygen cylinder. 

2. Using wrench, attach regulator and humid- 
ifier to cylinder. 

3. Attach tubing to humidifier. 

4. Select largest sized catheter that can be 
inserted comfortably in patient's nose. 

5. Attach catheter to tubing with connector. 



216 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




* 



Figure 249. — Measuring Catheter. 

Preparation of patient 

1. Tell patient how and what you are going to 
do. 

2. With the catheter, measure the distance from 
the tip of the patient's nose to the lobe of his ear; 
mark this point on the catheter with a small piece 
of tape. 

3. Turn valve on oxygen cylinder and adjust 
flow on regulator to 5-6 liters per minute. 




Figure 250. — Lubricating Tube 



Figure 251. — Testing Patency 
of Tube. 



4. Place small amount of lubricant on tissue; 
pass catheter lightly through the tissue. 

5. Hold tip of catheter in glass of water to be 
sure holes are not plugged. (Fig. 251.) 

6. Holding the catheter at the taped mark, ro- 
tate and find when its tip hangs at lowest level. 

7. Holding catheter in this position and with 
the oxygen flowing, insert the catheter into pa- 
tient's nose slowly up to the taped mark. 

8. Ask the patient to open his mouth; the tip 
of the catheter will be seen opposite the uvula. 

9. Tape catheter firmly at tip or side of nose 
and forehead. 




Figure 252. — Find the Droop of Catheter. 




Figure 253. — Position of Catheter. 




Figure 254. — Taping Catheter in Place. 



NURSING AND NURSING PROCEDURES 



217 



10. Loop elastic band around tubing and pin 
to bedding, leaving enough tubing to allow pa- 
tient to move about in bed. 

Care of patient with nasal catheter 

1. Apply vaseline, cold cream or mineral oil 
about nostril every 4 hours and prn. 

2. Give mouth care every 4 hours. 

3. Give fluids frequently. 

4. Watch patient; if he shows signs of restless- 
ness, dyspnea, cyanosis, check supply and flow of 
oxygen and the water level in humidifier. Check 
opening of catheter. 

5. Always have a clean catheter ready at bed- 
side. 

6. Catheter should be changed every 12 hours 
and more frequently if nasal secretions make it 
advisable. Use alternate nostrils each change. 

Care of catheters after use 

1. Wash catheters ; boil 5 minutes. 

2. Return to proper department. 

Face Mask (B. L. B.) Method 
Equipment : 

1. Mask. 

2. Oxygen cylinder, regulator, water bottle 
(humidifier). 

3. Wrench. 

4. Four feet of rubber tubing and connecting 
tip. 

5. Rubber band, safety pin. 

Procedure: 
In utility room 

1. "Crack" valve of oxygen cylinder. 

2. Connect regulator, humidifier, tubing and 
mask. 

At bedside 

1. Strap cylinder to bedpost. 

2. Turn on oxygen 6-10 liters per minute. 

3. Tell patient what you are going to do. 

4. Apply mask to patient's face. Ask him to 
exhale as it is applied. 

5. Adjust the head band so that the mask fits 
snugly but not too tightly. 

6. Reduce liter flow to 6-8 per minute (or 
rate ordered by doctor) after patient is accus- 
tomed to the mask. 




Figure 255. — Foce Mask in Position. 

7. Loop elastic band around tubing and pin to 
bed. Be sure tubing is long enough to allow 
patient to move about in bed. 

Care of patient with mask 

1. Every V/ 2 to 2 hours: 

Remove mask to sponge and dry patient's 
face and inside of mask. 
Give fluids to drink. 

Apply powder to patient's face if needed. 
Re-apply mask. 

2. Watch rebreathing bag; it should expand 
when patient exhales and deflate when patient 
inhales. 

3. Oxygen concentration is controlled by liter 
flow. 

For 100 percent oxygen concentration, ad- 
just liter flow to 6 to 8 per minute so that bag 
never completely collapses during inspiration. 

For 50 to 80 percent oxygen concentration, 
adjust flow to 5 to 6 liters per minute so that 
bag collapses during inspiration. 

For 40 to 50 percent oxygen concentration, 
adjust flow to 4 to 5 liters per minute so that 
bag collapses during inspiration. 

Patient should be comfortable with no dysp- 
nea, cyanosis; pulse should be slower and of 
better quality. If he isn't comfortable, check 



IV 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



oxygen supply, mask for leakage about nose 
and/or mouth. Small piece of gauze or cotton 
over bridge of nose or on chin may be neces- 
sary to prevent leakage. 

Care of mask after use 

1. Take mask apart. 

2. Wash all parts of mask thoroughly with 
soap and warm water; rinse. Wrap mask in 
cloth or gauze ; boil 5 minutes. 

3. Dry and reassemble mask; return to proper 
department. 

Tent Method 
Equipment 

1. Tent canopy. 

2. Oxygen machine. 

Iceless type — does not require ice and has own 
electrical air conditioning device. 

Ice type — requires ice (size of grapefruit) in 
cooling chamber, pail to catch water from melt- 
ing ice. 

3. Oxygen cylinder, regulator. 

4. Wall thermometer to hang inside tent. 

5. Hand bell for patient. 

6. Wrench. 

Procedure 

In utility room 

1. Check canopy for leaks. Mend with cel- 
lutape. 




2. Attach canopy to oxygen chamber. Close 
sleeves of canopy with clips or clothes pins. 

3. Fill ice chamber. 18 

4. Attach regulator to cylinder (if regulator 
is part of cabinet, attach to cylinder in patient's 
room). 

5. Fill humidifier to water level mark. 

At bedside 

1. Place rubber sheet between bottom sheet 
and mattress. 

2. Place patient in a comfortable position 
(Fowler's position preferred). 

3. Bring chamber and cylinder to the head 
of the bed. Strap tank to bed post away from 
radiator. 

4. Place bath towel around patient's shoul- 
ders. 

5. Check all connections; turn on oxygen to 
15 liters per minute. Open shutters in cham- 
ber ; place pail under drain. 

6. Place canopy over upper part of bed, tuck- 
ing it well under mattress at sides and back. 
Bring front of canopy down towards foot of 
bed. 

7. Fold cotton sheet in fourths ; place canopy 
within folds of sheets and tuck under mattress 
on both sides. 

8. After 20 minutes, reduce oxygen flow to 
8-10 liters per minute. 

Care of patient in tent 

1. Every time tent is opened, oxygen is lost! 

2. When giving a bath or changing the bed — 
Draw canopy up to patient's chin; tuck sides 

under pillow ; increase liter flow to 12 to 15 per 
minute. 

Use talcum powder for back rubs. 

3. When giving fluids use tent sleeves rather 
than opening entire canopy. 

4. Watch temperature inside tent — maintain at 
65° to 68° F. Protect patient's head with towel 
or OR cap if he complains of cold. 

5. Use oxygen analyzer every 4 hours to deter- 
mine concentration. Follow directions on ana- 
lyzer. 



Figure 256. — Preparation of Bed and Oxygen Tenf to Receive 
Patient. 



u Iceless type has own temperature control. Empty small 
drainage drawer on side of cabinet every 24 hours. Check and 
report any unusual sound in motor. 



NURSING AND NURSING PROCEDURES 



219 







Figure 257. — Administration of Fluids to Patients in Oxygen Tent. 



6. Watch patient carefully ; he should be much 
more comfortable inside tent. If he isn't, check: 

Oxygen supply, temperature. 
Tent for leaks. 

Inflow tube or shutter to see that it is not cov- 
ered by mattress or bedding. 

7. The tent is not soundproof; do not discuss 
patient's condition within his hearing distance. 

8. Be sure he has a hand bell and paper wipes 
within his reach. 

Care of tent after use 

1. If disposable type — discard. 

2. Other types : 

Wash with warm water and soap; rinse with 
cool water; dry. 

Allow to air for 24 hours. 
Return to proper department. 

CARBON DIOXIDE INHALATIONS 
(HYPERVENTILATION) 

Purposes : To relieve hiccoughs. To encourage 
deep breathing following surgery. 
Indicated : When ordered by doctor. 

METHOD I : Used only when specifically ordered. 

Equipment 

1. Small cylinder 92 percent oxygen, 8 percent 
carbon dioxide. 

2. Connector, 2 feet rubber tubing. 

Procedure 

1. Connect cylinder, connector, and tubing. 

2. Turn on flow of gas. 



3. Hold tube 6 inches from patient's face. 

4. Deep breathing should occur in 30 seconds. 

5. Caution ! If deep breathing does not occur 
within 1 minute, the administration should be 
stopped, for serious depressant effects are likely 
to follow. 

METHOD II: Paper bag method 
(See "Postoperative Discomforts.") 

Nebulizer Therapy 

Purpose: Local application of medication to 
the respiratory tract. 

This method is used only when aqueous solution 
of medication is to be employed. 

Equipment 

1. Oxygen cylinder. 

2. Flow regulator. 

3. Rubber tubing, 3 feet. 

4. Nebulizer. 

5. Aqueous solution ordered. 




Figure 258. — Nebulizer in Use. 



220 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Procedure 

1. Assemble oxygen tank and regulator as for 
oxygen therapy. Set flow to 4 liters. 

2. Place drug in nebulizer. 

3. Connect nebulizer to tubing. 

4. Have patient insert nebulizer tip in his 



mouth, caution him to keep his lips closed about 
tube. 

5. Treatment lasts approximately one-half hour 
or until all medication is used. 

CAUTION ! For safety's sake use a hand nebu- 
lizer when oily solutions are ordered to be admin- 
istered. 



THE ADMINISTRATION OF PARENTERAL FLUIDS 

Review — Chapter II, "The Blood and Blood Vascular System" 

Chapter III, "Plasma and Plasma Administration" 

Chapter X, "Blood Grouping and Matching" 



The average intake of fluids by a normal indi- 
vidual of average size is about 3,000 cc. This in- 
take consists of the fluid taken as fluid, the fluid 
taken in solid foods, and the water given up as a 
result of oxidation. The average output of fluid 
is about the same. This output is that excreted 
by the kidneys in the form of urine, that lost by 
the skin through evaporation, and that lost by the 
lungs through the expiration of air. Fluid is lost 
by the digestive tract in the form of feces. Dur- 
ing illness fluids may also be lost through vomitus 
and hemorrhage. 

When a large amount of fluid is lost by the body, 
it must be replaced. Ordinarily, adequate fluid 
intake may be maintained by fluids taken by 
mouth. When a patient is unable to take sufficient 
fluids b}^ mouth or when his fluid loss has been so 
great that his intake must be supplemented, fluids 
are administered by other methods. The doctor 
may decide to supply fluid by gastric gavage, re- 
tention enema, hypodermoclysis, intravenous in- 
fusion, or transfusion. See "Procedures Relating 
to Gastrointestinal Tract" for gavage and reten- 
tion enema procedures. 

The administration of fluids by hypodermocly- 
sis or intravenous methods is the responsibility of 
the doctor or of a person trained by him. The 
corpsman's role is one of assisting with these pro- 
cedures. In order to intelligently assist he should 
know: 

1. How to prepare his patient and his unit. 

2. What and how to prepare necessary equip- 
ment. 

3. How to assist the doctor. 



4. What symptoms, reactions are expected and 
what danger signs may occur as a result of the 
treatment. 

INTRAVENOUS THERAPY 

Definition: Introduction of large amount of 
fluid into vein. 

Purposes: To supply medication and fluids to 
body; to increase blood volume; to supply nour- 
ishment to body. 

Principles 

1. Only fluids specially prepared for intrave- 
nous therapy are used. 

2. Intravenous therapy is administered under 
strict aseptic conditions and techniques. 

3. Intravenous fluids are given at room temper- 
ature. 

4. Use correct apparatus for the type of fluid 
to be given. Blood and plasma require the use of 
a filter (fig. 259). 

5. Regulate flow of fluids as ordered by the doc- 
tor. 

6. Use separate tubing for amino acids. 

7. All intravenous therapy is started by doctor 
or trained assistant under direct supervision of the 
doctor. 

8. Know dangers of intravenous therapy. Re- 
action may be due to poor technique, too rapid 
administration or patient's idiosyncrasy. 

Infection — due to unsterile equipment or poor 
technique. 

Embolism — due to presence of air in tubing. 



NURSING AND NURSING PROCEDURES 



221 





FXJ5) 



Iff 






INFUSION TRANSFUSION HYPODERMOCLYSIS 

Figure 259. — Types of Drip Regulators. 

Infiltration — due to needle being out of vein, 
causing fluid to enter tissues. 

Blood — due to incompatibility and faulty 
cross matching. 

9. Symptoms of dangers of intravenous ther- 
apy. Reaction may be a chill, increased pulse, 
respiration and temperature (spiking), vertigo, 
restlessness, hives, lumbar pain, dyspnea, cyanosis, 
nausea, and vomiting. 

Infection — may be immediate or delayed. 
Symptoms may be same as those listed under 
reaction. 

Embolism or blood incompatibility — sudden 
dramatic pain, cyanosis, dyspnea, increased 
pulse rate. 



Infiltration — swelling and coldness at site of 
injection. Patient may or may not complain of 
pain. 

10. Treatment of dangers of intravenous 
therapy. 
Stop intravenous at first sign or symptom. 

Notify doctor; give emergency measures. 
(In cases of severe cyanosis and dyspnea may 
include oxygen.) 

In case of chill, apply extra blankets, hot 
water bottle to feet; give warm or hot fluids by 
mouth if patient is able to take them. 

Send tubing and containers to blood bank lab- 
oratory for possible bacteriological studies. 
Parenteral fluids may be whole blood; plasma ; 
solutions of physiological saline; physiological 
saline with glucose ; amino acids ; buffer salts. 

Sites of injections 

1. Median cubital, cephalic or basilic veins. 

2. Dorsalis pedis vein. 

Equipment 

Standard. 

Solution ordered. 

Container of alcohol sponges. 

Curved basin. 

Small covered rubber sheet. 

Technique forceps in container of disinfectant 
solution. 

Disposable intravenous set. 

Correct apparatus for fluid being administered. 

Arm board. 

Bandage and scissors. 

Adhesive tape, i/^-inch width cut in 6-inch 
lengths. 

Tourniquet. 

Sterile needle pack from CDR (two gauze flats, 
one airway needle, one 19-gage by 1^-inch needle, 
screw clamp). 

Preparation of Patient and his Unit 

1. Explain procedure to patient, tell him how 
he may help. 

2. Do any nursing measures required before 
setting-up for intravenous. 

3. Offer bedpan or urinal; remove sleeve of 
gown from arm to be used. 

4. Place small covered rubber sheet under arm 
and tourniquet above site of injection. 



222 



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Figure 260. — Preporation of Patient for Intravenous Infusion. 

5. Clear bedside stand of everything except 
equipment needed. 

6. Place standard at foot of bed or fix pole 
attachment on bed. 

Preparation of solution 

1. Hold solution bottle up to the light. Solu- 
tion should be clear without sediment or shreds 
of mold. 

2. Remove cap (fig. 261). 

3. Open needle pack ; remove airway needle. 

4. When airway needle is inserted, a rush of air 
into bottle should be heard. 

5. Attach tubing — 

Place screw clamp on tubing. 

Remove protective rubber cap from tip of 
drip regulator; insert tip into large depression 
of rubber stopper of solution bottle. 

Invert solution bottle; hang on standard. 

6. Holding tubing higher than bottle, remove 
rubber cap from needle adapter. Slowly lower 
tubing; allow solution to run through tubing into 
curved basin until entire tubing is filled with solu- 
tion; all air bubbles expelled. Attach needle; 
clamp tubing (fig. 262). 

Procedure 

1. Cleanse site of injection with alcohol sponge. 

2. Apply tourniquet. 

3. Doctor inserts needle. When blood appears 
in tubing, release tourniquet and open clamp. 

4. Secure needle in place with adhesive. A 
gauze sponge may be necessary to hold needle at 
correct angle of injection. 





I. Remove metal strip 
around outside top 



2. Remove metal disc 

3. Remove rubber disc. Do not 
touch black rubber ! 

4 Insert sterile needle (18 G.) 
into "0", then remove and 
insert into " " 




Figure 261. — Removing Cap of Solution Bottle. 

5. Regulate flow 40 to 60 drops per minute or 
at rate ordered by doctor. 

6. Watch for signs of reaction, infiltration. 

Care of patient during treatment 

1. Watch for any sign of the patient's being 
chilly or shivering. Clamp tubing immediately. 
Notify ward doctor or nurse at once. 

2. Keep patient quiet, especially that part of 
body where needle is inserted. Watch for and 
report any swelling around needle. 

3. Watch the drip regulator and report if fluid 
stops flowing. 

4. Take pulse frequently ; watch color of patient. 

Care of patient after treatment 

1. When solution bottle is almost empty — 

Clamp tubing. 

Remove adhesive. 

Place alcohol sponge over needle. 

Withdraw needle ; exert pressure over site of 
injection until bleeding stops. 



NURSING AND NURSING PROCEDURES 



223 




Figure 262. — Preparation of Solution. 

2. Straighten patient's clothing and bedding; 
make patient comfortable. 

3. Take all equipment to utility room. 

Care of equipment 

1. Discard tubing. 

2. Rinse needle with cold water; wash with 
warm soapy water; rinse. Use cotton applicator 
to clean hub of needle. 

3. Return bottle and needle pack to CDR. 

Chart — Nursing Notes 

1. Time of start and completion of intravenous. 

2. Amount, solution, and by whom started. 

3. Any reaction noted. 

4. Signature. 



Hypodermoclysis 

Definition: Slow introduction of a large 
amount of fluid into the subcutaneous tissue. 

Fluids: Normal saline (physiological saline); 
Glucose 2 to 5 percent in normal saline. 

Purpose: To supply body with fluids; to re- 
store fluid balance; to supply fluids to the body 
when intravenous is contra indicated. 

Sites of injection 

1. Anterior aspect of the thighs. 

2. Subcutaneous tissue under breasts. 

Equipment 

1. Sheet. 

2. Standard or pole attachment on bed. 

3. Container alcohol sponges. 

4. Technique forceps in container of disinfect- 
ant solution. 

5. Disposable hypodermoclysis set; solution. 

6. Package of sterile towels. 

7. One-half inch adhesive tape cut in 6-inch 
lengths. 

8. Sterile needle pack from CDR (two gauze 
4 x 4, 1 airway needle, two 18-gage 3-inch needles, 
two screw clamps). 

Preparation of patient and his unit 

1. Explain procedure to the patient; tell him 
how he may help. 

2. Do any nursing measures required before set- 
ting up hypodermoclysis. 

3. Clear top of bedside locker of everything ex- 
cept the equipment needed. 

4. Place standard at foot of the bed or fix pole 
attachment on the bed. 

Preparation of solution 

1. Same as for intravenous infusion. 

2. Apply screw clamp to each tube. 

3. Attach 18-gage needle to each tube. 
Procedure (injection site — anterior aspect of 

thighs) 

1. Fold back bedclothes to patient's knees. 

2. Place a sheet over patient's body, exposing 
only thighs. 

3. Cleanse site of injection with alcohol sponges. 

4. Fold sterile towel over bedclothes at patient's 
knees. 

5. Doctor inserts a needle into subcutaneous tis- 
sues of each thigh. 



224 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 263. — Hypodermoclysis. 

6. Open clamps; regulate flow to 40 drops per 
minute or rate ordered by doctor. 

7. Place sterile 4 x 4's over needles; hold in 
place with adhesive tape. 

8. Place a sterile towel over field. 



Care of patient during treatment 

1. Watch the site of injection. If area becomes 
hard, blanched and/or painful, stop flow until the 
fluid is absorbed and then open clamp. 

2. When solution has been given, clamp tubing ; 
remove needles and cover site of injection with 
dry sterile dressings. 

Care of patient after treatment 

1. Place patient in a comfortable position, pref- 
erably other than the one he has maintained dur- 
ing the treatment. 

2. Take all equipment to utility room. 

Care of equipment 

1. Discard tubing. 

2. Rinse needles with cold water; wash with 
warm soapy water ; rinse. Use cotton applicators 
to clean hubs of needles. 

3. Return bottle and needle pack to CDR. 

Charting — Nursing notes 

1. Time of the start and completion of the 
hypodermoclysis. 

2. Amount, solution, and by whom started. 

3. Condition of site of injection on completion 
of treatment. 

4. Any other reactions noted. 

5. Signature. 



APPLICATIONS OF HEAT AND COLD 

Review — Chapter II, "The Blood and Blood Vascular System" 
"The Lymph and Lymph Vascular System" 
"The Skin" 
"The Nervous System" 



The applications of heat and cold as described 
in this section will be limited to those procedures 
you will be likely to use on the ward or in sick bay. 
There are many other methods (lamps, dia- 
thermy, etc.) of applying heat and cold that are 
administered by the physical medicine depart- 
ment. 

The effects of heat and cold 

Heat expands; cold contracts. When two ob- 
jects of different temperatures come in contact, 



heat is lost to the cooler object. When moisture 
is present the effects are more penetrating. In the 
application of heat and cold to the body the same 
effects occur. 

The form of application, the temperature at 
which it is to be applied, and the duration of the 
application, will be prescribed by the doctor. 

General instructions 

1. Always have a doctor's order for all applica- 
tions of heat and cold. 



NURSING AND NURSING PROCEDURES 



225 




# • * *nn.\VSSv 






u a 



o • 




EFFECTS OF COLD 
Capillaries constrict. Less blood flows 
to the part. Circulation is lessened. 
Pain is relieved (anesthetic effect). 



Figure 264.- 



NORMAL 
-Effects of Heat and Cold. 



EFFECTS OF HEAT 
Capillaries dilate. More blood flows 
to the part. Circulation improves. Pain 
is relieved. Draining is promoted. 



2. Always explain the procedure to the patient. 

3. Always screen the patient when applying 
moist heat or cold. 

4. Always wash your hands before starting pro- 
cedures. 

5. Always have a layer of cotton, flannel, or 
woolen cloth between the patient and any rubber 
or plastic materials. 

6. Always watch the patient's skin closely for 
signs of redness, mottling, edema, or maceration. 

7. Always chart procedure, noting : 
Time of application. 

Form of application. 
The area to which it was applied. 
The duration of the application. 
The name, strength, and temperature of solu- 
tion (moist applications). 

The local and/or the systemic effects noted. 
Your signature. 

APPLICATIONS OF DRY HEAT 

Dry heat may be applied to the body by means 



of a heat cradle, an electric pad, or a hot water 
bottle. 

Purpose: To provide warmth and comfort; to 
relieve pain ; to soothe and relax superficial tissue. 

Heat Cradle 

Heat cradles are frames of various sizes 
equipped with electric light bulb(s) or heating 
element to provide warmth to the patients with 
circulatory disturbances or extensive burns. 

Precautions 

1. Check all electrical connections and wiring 
before using cradle. 

2. Be sure the cradle is large enough to cover 
the affected area and to permit the patient to move 
without being burned. 

3. Secure the cradle to the bed to prevent it from 
slipping down over the side and burning the 
patient. 

4. Note t he temperature inside the cradle. Those 
having heating elements are controlled by thermo- 
stats. For those having electric light bulb(s) : 

Suspend a wall thermometer inside the cradle. 



226 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Control temperature by turning bulb(s) on 
and off. (The usual desired temperature inside 
the cradle is 90° to 95° F.) 
5. Electric light bulbs should be 25 watt or less 
and covered by shields. 

Electric Pad 
Precautions 

1. Check connections and wiring before using. 

2. Keep temperature control on "low." 

3. Do not use with wet applications. 

Hot Water Bottle 
Equipment 

1. Hot water bottle and cover. 

2. Pitcher of water 120° F. 

Procedure 

1. Test bottle for leaks. 

2. Fill bottle one-half full. 

3. Place bottle on flat surface ; press from bot- 
tom of bottle until water appears in neck of bottle. 
Close tightly. 

4. Wipe dry; test for leaks; place cover on 
bottle. 

5. Apply bottle to prescribed area with neck of 
bottle away from patient's body. 




Precautions 

1. Always cover bottle. 

2. Refill as necessary to keep hot. 

3. Observe patient's skin frequently for signs of 
redness, blistering, and pain. 

APPLICATIONS OF MOIST HEAT 

Moist heat may be applied to the body by means 
of wet compresses, packs or baths. Irrigations 
and inhalations are also methods of applying moist 
heat and are discussed in detail elsewhere in the 
text. The purposes of applying moist heat are: 

1. To relieve inflammation. 

2. To provide comfort. 

3. To relieve pain. 

4. To hasten the localization of infection. 

Moist Hot Compresses (Clean) 

Purpose: When moist heat is desired for a 
small area. 

Equipment 

Tray. 
Hot plate. 

Basin of water or solution (105° F.). 
Compress of sufficient size to cover area — may 
be gauze or flannel or a wash cloth. 
Emesis basin. 
Rubber sheet and cover. 

Procedure 

1. Place compresses in basin of solution on hot 
plate. Turn on hot plate. 




Figure 265. — Filling Hot Water Bottle. 



Figure 266. — Moist Hot Compresses. 



NURSING AND NURSING PROCEDURES 



227 



2. Place covered rubber sheet under part to be 
treated. 

3. Wring out excess solution; place compress on 
part. 

4. Repeat step 3 every 1 to 2 minutes for 20 
minutes or for prescribed length of time. 

Precautions 

1. Wring compresses dry as possible before 
placing on patient. 

2. Observe skin carefully for redness, pain, and 
blistering. 

3. Keep hot plate on "low" after once heated. 

Sterile Hot Wet Compresses 

Used when open lesion or wound is present. 
Equipment 

Tray. 

Hot plate. 

Sterile basin and solution (105° F.). 

Sterile compresses, gauze. 

Two sterile forceps. 

Curved basin. 

Rubber sheet and cover. 

Procedure 

Wash Your Hands! 

1. Place covered rubber sheet under part to be 
treated. Turn hot plate to "low." 

2. With forceps, place sterile compresses in basin 
of solution on hot plate. 

3. With sterile forceps, wring out excess solu- 
tion ; apply slowly to part. 




Figure 267. — Sterile Hot Wet Compresses. 



4. Repeat step 3 every 1 to 2 minutes for 20 
minutes. 

Precautions 

1. Start compresses at low temperature (105° 
F.) to allow patient to become accustomed to them. 

2. Maintain aseptic technique. 

3. Watch closely for signs of burning (redness, 
blisters, pain). 

4. Wring out compresses as dry as possible. 

5. Keep hot plate on "low." 

6. If infection and discharge are present, use 
each compress once only. 

7. If for both eyes, use separate set-ups for each 
eye, wash hands between and after eye treatments. 

Local Packs 

Local packs are used to provide moist heat to 
a large area. This is a clean procedure. 

Equipment 

1. Cotton flannel or pieces of old, clean blan- 
keting. 

2. Rubber sheet. 

3. Sheet or bath towel for binder. 

4. Vaseline or oil for skin. 

5. Safety pins or bandage to hold binder in 
place. 

6. Basin of water 110 to 115° F. 

Procedure 

1. Place flannel or blanketing in basin of water. 

2. Place rubber sheet and binder under the part 
to be treated. 

3. Lubricate the skin. 

4. Wring out the flannel as dry as possible; 
apply around part to be treated. 

5. Wrap rubber sheet around flannel. 

6. Wrap binder around rubber sheet ; pin or tie 
in place. 

7. Change wet flannels every half -hour; note 
the condition of the skin. Report signs of puffi- 
ness, blisters, wrinkling, paleness of the skin. 

Precautions 

1. Be sure flannel or blanketing is large enough 
to cover area. 

2. Be sure flannels are wrung out as dry as pos- 
sible to avoid burning patients by steam. 

3. When applying wet flannel place it gently on 
the part and momentarily lift the corner to allow 
the escape of steam. 



228 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



4. When packs are ordered continuously, expose 
the area to the air for one-half to one hour daily 
to help prevent maceration of the skin. 

5. Hot water bottles are occasionally used to 
maintain a constant heat. Place them inside the 
binder next to the rubber sheet. Be sure they are 
no hotter than 120° F. 

6. When a broken skin area or a wound is pres- 
ent, use sterile water, sterile abdominal pads for 
dressings; use sterile technique. 

Lay on Packs 

Lay on packs may be used to provide moist heat 
to a large area to relieve painful muscle spasm. 
They are applied when the patient is in either 
prone or supine position. The areas to be packed 
and the frequencies of the packs are prescribed by 
the doctor. 

The packs consist of three layers of material: 

The inner or hot moist layer — old clean blanket- 
ing cut to fit the part to be treated. 

The waterproof layer — plastic material, oiled 
silk or similar material cut to the same size. 

The outer layer — blanketing cut slightly larger 
than the other layers. 

Equipment 

Pack machine. 

Several pieces of blanketing for inner layer. 

Waterproof material for middle layer. 

Blanketing for outer layer. 

Long handled forceps or tongs. 

Bath towels. 

Procedure 

Preparation of equipment 

1. Place pack machine in operation according 
to the directions on the machine. 

2. Place the inner layers in top of machine. 

3. Wheel machine close to bedside. 

Preparation of patient and unit 

1. Check the temperature of the unit (72° F.). 

2. Place patient in desired position. See page 
182 for proper supine or jn-one position. Note the 
supports to be used. 

3. Place outer and middle layers of pack in or- 
der of use on the patient's bed near the part to 
which they are to be applied. 




Figure 268. — Application of Lay-on Pack. 




Figure 269. — Lay-on Packs showing Three Layers of Pack. Note 
Patient's Position. 

Method 

1. One corpsman removes one inner layer from 
machine with forceps. 

2. Second corpsman receives inner layer, tests it 
for moisture, then gently applies it to the part. 
If it is too hot, the layer is raised, skin patted dry 
with a bath towel and the layer again applied. 
It is then quickly covered with waterproof mate- 
rial and the outer layer of dry blanketing. The 
three layers are then made to conform to the part 
being treated. 

Care of the patient during packs 

1. The inner layer may be changed as often as 
every 15 minutes, proceed as above. Have the 
new inner layer ready to apply before removing 
the outer and middle layers. 



NURSING AND NURSING PROCEDURES 



229 



2. Watch the patient's color and pulse rate. A 
thready, irregular pulse, cyanosis, or pallor indi- 
cates that the pack should be discontinued. 

3. Take the patient's temperature, If the tem- 
perature is high, cool sponging between packs may 
be necessary. An ice bag or cold compresses to the 
forehead may help the patient tolerate the packs. 

4. Push fluids. 

5. Watch patient's skin. Dry body by gently 
blotting with a soft towel between packs. 

6. Watch the body alignment, Maintain the 
patient's position in good anatomical alignment. 

Care of the patient after pack 

1. Dry body by gently blotting with a soft towel. 

2. Place patient in a comfortable position or 
place in position prescribed by the doctor. 

3. Continue to give fluids frequently. 

4. Continue to observe patient. 
Precautions 

1. Be gentle with the patient. If it is necessary 
to lift a part, lift at the joints. Avoid touching 
the body of the muscle. 

2. Avoid burning the patient by testing inner 
layers for excessive moisture before applying; by 
raising the layer momentarily after applying it. 

3. Watch patient closely for untoward reac- 
tions; i. e., change in color, increased pulse rate, 
profuse perspiration. 

4. If patient complains of itching, place a single 
layer of fine gauze over the part to be treated and 
then apply the inner layer. If patient is allergic 
to wool, cotton material may be substituted. 

5. In the presence of infectious disease use med- 
ical aseptic techniques (pp. 262-268). Keep pack 
materials separate for each patient. 

(i. Watch for signs of fungus growth on pack 
materials. Mouldy odor is one of the first signs. 
Blanketing used for inner layers should be washed 
and allowed to dry completely every 24 hours. 

7. Omit outer layer when pack is applied to the 
chest to avoid excess weight on patient's chest. 

Note. — If pack machine is hot available, a steri- 
lizer and a clothes wringer may be used. 

If these are not available : Boil packs in a wash 
boiler or large basin for 20 minutes. Use impro- 
vised wrinjrer. 



Improvised wringer — Equipment 

Two broomsticks or mop handles cut to 18-inch 
lengths. 

One canvas or other heavy material 24 inches 
wide. 24 inches long. 

Sewing needle and stout thread or sewing ma- 
chine. 

Method 

1. Fold material lengthwise toward the center. 

2. Lap over 3 inches of material at both ends 
and stitch. 

3. Insert sticks into loop at each end. 

4. With forceps, place wet blanketing inside 
folded material. 

5. Grasp sticks and wring dry by pulling out- 
ward and twisting. 





Figure 270. — Improvised Wringer. 



211806°— 53- 



-10 



230 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Hot Wet Soaks of Arm or Foot 
Equipment 

Foot tub one-fourth full warm water (105° F.). 
Pitcher hot water (115° F.). 
Rubber sheet and cover. 
Bath towel. 

Procedure 

Wash your hands ! 

1. Place covered rubber sheet under part to be 
treated. 

2. Place foot tub on rubber sheet. 

3. Place part to be treated in tub. 

4. Pour hot water into tub slowly, away from 
patient's extremity ; stir water as you pour. 

5. Repeat step 4 as necessary to keep water hot. 

6. Continue for 20 minutes. 

Precautions 

1. Pour hot water away from extremity to avoid 
burning patient. 

2. Have tub on level surface to avoid spilling 
water. 

3. Cover top of tub to hold in heat. 

4. Watch skin carefully for signs of burning. 

Sitz Bath 

Used in treatment of rectal, perineal, or pelvic 
conditions. 

Equipment 

1. See procedure for tub bath. 

2. Amount of water should be sufficient to cover 
patient's hips. 

3. Temperature of water (110° F.). 

4. Duration of treatment, 20 minutes unless 
time is specified by doctor. 

Precautions 

If patient shows signs of dizziness, fainting, or 
exhaustion, stop treatment, drain water from tub, 
cover patient with blanket. Report to doctor. 

APPLICATION OF DRY COLD 

Dry cold is usually applied to the body by means 
of an ice bag or ice collar. 

Purpose: To check inflammation; to relieve 
pain ; to check bleeding. 



Ice Bag 

Equipment 

Ice bag and cover. 

Cracked ice (size of walnut). 

Procedure 

1. Test bag for leaks. 

2. Fill bag one-fourth full of ice. 

3. Place on flat surface; press from bottom of 
bag until ice appears in neck of bag. Close 
tightly. 

4. Wipe dry; test for leaks; place inside cover. 

5. Apply bag to prescribed area with neck of 
bag away from patient's body. 

Precautions 

1. Alwaj's cover bag. 

2. Change cover when it becomes moist. 

3. Refill as necessary to keep cold. 

4. Observe patient's skin frequently for signs 
of mottling, numbness, pallor, complaint of 
burning sensation. 

Ice Collar 

Follow same procedure. Use crushed ice. 
Cover collar by wrapping it with gauze bandage. 

APPLICATIONS OF MOIST COLD 

Moist cold may be applied to the body by means 
of compresses and baths. 

Purpose: To prevent or reduce swelling; to 
relieve pain; to reduce temperature. 

Cold Moist Compresses (Clean) 
Method I — Equipment 

Tray. 

Basin of ice water. 

Compresses of sufficient size to cover area — may 
be of gauze or flannel or a wash cloth. 
Curved basin. 
Rubber sheet and cover. 

Procedure 

Wash your hands ! 

1. Place covered rubber sheet under part to be 
treated. 

2. Place compresses in ice water. 

3. Wring out excess solution ; place compresses 
on part. 



NURSING AND NURSING PROCEDURES 



231 




Figure 271. — Clean, Cold, Moist Compresses, Method I. 

4. Repeat step 3 every 1 or 2 minutes for 20 
minutes or for prescribed period of time. 

Precautions 

1. Watch skin carefully for signs of blanching, 

mottling. 

2. Wring compresses dry as possible before 
placing on patient. 

Method II — Equipment 

Tray. 

Wash basin. 

Gauze 18 x 18. 

Block of ice. 

Compresses. 

Curved basin. 

Rubber sheet and cover. 




Procedure 

1. Secure gauze over top of basin. 

2. Wash off ice; place on gauze. 

3. Moisten compresses with clear water, place 
on ice. 

4. Proceed as in steps 3 and 4, method 1. 

Cold Moist Compresses (Sterile) 
Equipment 
Tray. 

Face basin with cracked ice. 

Sterile solution basin, solution. 

Two sterile forceps. 

Sterile compresses (gauze). 

Curved basin. 

Rubber sheet and cover. 




Figure 272. — Clean, Cold, Moist Compresses, Method II. 



Figure 273. — Sterile, Cold, Moist Compresses. 

Procedure 

Wash your hands ! 

1. Place rubber sheet under part to be treated. 

2. With sterile forceps, place sterile compresses 
in solution basin: then place basin in cracked ice. 

3. With sterile forceps, pick up compress; wring 
out excess solution; apply to part. 

4. Repeat step 3 every 1 to 2 minutes for 20 
minutes. 

Bath — Tepid Sponge 

Purpose: To reduce fever. 

Indicated: When ordered by doctor or for pa- 
tients with fever of 103° F. or over. 



232 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 274. — Equipment for Tepid Sponge. 

Equipment 

1. Bath basin one-half full of cool water (95° 
to 100° F.). 

2. Seven wash cloths or seven pieces of gauze. 

3. Bath towel. 

4. Hand towel. 

5. Rubbing alcohol (50 percent). 

6. Rubber and cotton draw sheet. 

7. Hot water bottle and cover. 

8. Ice cap and cover. 

Procedure 

Wash your hands ! 



1. Preparation of patient and his unit is the 
same as for cleansing bed bath and : 

Place rubber and cotton draw sheets under 
patient. 
Place ice cap to head, hot water bottle to feet. 

2. Order of sponging patient. 

Wring out wash cloths in cool water; place 
one in each axilla, groin, and under each knee. 
Beplace wash cloths frequently. 

Follow same order in sponging patient as for 
cleansing bed bath. Omit genitalia and soaking 
feet. Pat body dry; avoid vigorous rubbing. 
Apply alcohol to arms and back. 

Watch patient for signs of chilliness, cya- 
nosis; increased pulse rate. 

Continue treatment for 20 minutes — unless 
patient shows reaction. In case of reaction, stop 
sponge; apply blankets and report reaction to 
ward nurse or doctor. 

Remake bed ; leave patient comfortable. 

Remove, clean, and store equipment. 

Take TPR one-half hour after treatment is 
completed. 

If alcohol sponge is desired, use bathing solu- 
tion — 1 part water to 1 part alcohol. Proceed as 
above. 



PROCEDURES RELATING TO THE GASTROINTESTINAL TRACT 
Review, Chapter II, "The Digestive System" 



The treatments relating to the gastrointestinal 
tract are prescribed either to cleanse the area, to 
apply heat, to administer or remove fluids, or to 
administer medication. Most of these treatments 
require clean equipment and solutions except in 
the presence of gastric surgery when sterile 
equipment is needed. All equipment used in these 
treatments must be sterilized after each use and 
the returns from these treatments should be dis- 
carded down the hopper or bedpan flusher. 

Mouth care : See "Oral hygiene." 

Intubation 

The introduction of tubes through the nose or 
mouth into the stomach is usually the responsibil- 
ity of the doctor. However, there are times when 
a corpsman may be called upon to insert a stomach 
tube or to teach his patient how to do so. 



Purposes: To obtain a specimen of gastric con- 
tents for laboratory examination; to prepare the 
patient for a gastric lavage, gavage or suction 
siphonage. 

Types of gastric and intestinal tubes: 

Levin tube. — This is a flexible, soft-walled, 16 
French, 4-foot tube. It has multiple holes near the 
rounded tip. Markings on the tube indicate dis- 
tances of 50, 60, 70, and 80 centimeters. The 
Levin tube is used for gastric and intestinal drain- 
age, gastric lavage and gavage. It may be inserted 
either nasally or orally. It is flexible enough so 
that there is little danger of producing injury. 
The chief danger is that the tube may readily enter 
the trachea (fig. 275). 

Stomach tube.— This is a stiff, heavy-walled, 28 
French, 5-foot tube .with a round tip and a funnel 
at the other end. The stomach tube i* used for gas- 
tric lavage. It is stiff enough to be easily passed 



NURSING AND NURSING PROCEDURES 



233 



into the stomach of an unconscious or uncoopera- 
tive patient. The chief danger is that the tube, 
due to its stiffness, may damage the larynx or per- 
forate the stomach or esophagus if not carefully 
used (fig. 276). 

Cantor tube. — This is a single lumen, No. IS 
French, 10-foot intestinal tube with a small mer- 
cury-filled bag at its tip. It is used for intestinal 
drainage and to relieve intestinal obstruction. The 
tube is inserted nasally, suction is started when the 
letter "S" on the tube is at the patient's nose 
(fig. 277). 




Figure 275. — Levin Tube. 



Figure 276. — Stomach Tube. 




Figure 277. — Cantor Tube. Figure 278. — Miller Abbott Tube. 

Miller-Abbott tube. — This is a metal tipped, 
double lumen, No. 16 French, 10-foot intestinal 
tube with a small balloon near its tip. One lumen 
of the tube is used to inflate the balloon ; the other, 
entirely independent, for aspiration. Markings 
on the tube indicate the distance it has been passed. 
The tube is inserted nasally and suction is started 
when the first mark is at the patient's nose. Peri- 



staltic action carries the balloon and tube along 
the intestine (fig. 278). 

Intubation Technique (Nasal) 

Equipment 

Levin tube in basin of ice water. 

Water soluble lubricant. 

20 to 30 cc. syringe. 

Bath towel. 

Rubber sheet. 

Paper mouth wipes. 

Curved basin. 

Procedure 

1. Place patient in Fowler's or sitting position. 
Explain procedure to him. 

2. Secure bath towel around his neck. Place 
rubber sheet over bedding. 

3. Remove tube from ice water. Lubricate tip 
very lightly. 

4. Ask patient to tilt head slightly backward. 

5. Hold tube about 6 inches from its tip. 
Rotate it until position of greatest "droop" is 
found. 

6. Holding tube in this position, pass it through 
the nostril into the pharynx. Ask the patient to 
swallow. Each time he swallows insert the tube 
a few inches. Do not use force. Continue in- 
serting the tube until second marker on tube is 
reached. 

Caution. — Should patient start coughing, chok- 
ing or become cyanotic; remove tube quickly. 
Allow patient to rest a few minutes. Re-insert 
tube. 

7. Attach syringe to tube and aspirate gastric 
contents. 

8. To remove tube : 

Place towel close to patient's chin. 
Pinch tube at patient's lips. 
Gently but quickly remove tube and place it 
directly into towel. 

Intubation technic oral — see Gastric Lavage. 

Suction Siphonage (Wangensteen) 

Purpose: To provide constant drainage of the 
gastrointestinal tract. 

Indicated : When ordered by doctor : 

To relieve or prevent abdominal distention; 
to remove gas or fluids from gastrointestinal 



234 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



tract, to relieve intestinal obstruction ; to relieve 
postoperative nausea and vomiting. 

Types of suction apparatus 

1. Three bottle method. — A partial vacuum is 
created in the drainage bottle by the flow of wa- 
ter from the top bottle to the bottom bottle. 

2. Hand pump method. — A partial vacuum is 
created in the drainage bottle by pumping some 
air out of the tank. 

Both types. — Since the pressure in the drainage 
bottle is lower than the pressure in the stomach, 
the stomach contents are siphoned into the drain- 
age bottle. 

Three Bottle Method 
Equipment: From CDR 

Siphonage unit. 

Levin tube. 

Glass connecting tip. 

On ward 

Lubricant for tube. 
Basin of cracked ice. 
Curved basin. 
Rubber sheet and cover. 

Adhesive strips {}/%" wide x 6" long — split 
halfway down the middle). 
Safety pin. 
Elastic band. 
Large paper bag to cover drainage bottle. 

Procedure 

Preparation of equipment 

1. Place Levin tube on ice. 

2. Attach connecting tip to tubing of drainage 
bottle. Close clamp on tubing. 

3. Invert center bottles, water will start flowing 
from top to bottom bottle. 

4. Open clamp, test for suction by placing finger 
over opening. Close clamp. 

5. Take all equipment to bedside. 

Preparation of patient 

1. Screen and tell patient what is to be done. 
Levin tube is introduced. See "Intubation Tech- 
nique" (p. 233). 

2. Attach Levin tube to connecting tip of drain- 
age bottle. Open clamp. 

3. Tape Levin tube to patient's forehead or 
cheek. 




Figure 279. — Wangensteen Apparatus. 

4. Loop elastic band about tubing near connect- 
ing tip, pin to bedding. 

5. Place drainage bottle in paper bag. 

During treatment 

1. Invert center bottles whenever top one is 
empty. 

2. Empty drainage bottle when it becomes two- 
thirds full or every 12 to 24 hours. 

To empty drainage bottle : 

Close clamps on tubing to center bottles and 
Levin tube. 

Unscrew cap, remove bottle. 

Measure and note contents. 



NURSING AND NURSING PROCEDURES 



235 



Rinse bottle with cold water, wash with soap 
and water. 

Replace bottle, screw on cap, open clamps. 

3. Watch working order of apparatus; report 
any signs that siphonage is not working. 

4. Keep accurate intake and output records. 

5. Give mouth care every 4 hours. (Patient 
may have chewing gum if ordered.) 

6. Apply ointment or oil to each nostril every 

4 hours. 

7. Do not clamp tubing or stop siphonage unless 
ordered by doctor. 

8. Give only clear fluids by mouth if ordered 
(water, tea, black coffee, broth, strained soups. No 
milk, solids). 

9. Irrigate tube as ordered. 

10. Observe patient. Report any complaints of 
nose and throat irritation; any signs of blood in 
drainage. 

Charting nursing notes 

Time of starting treatment. 
Patient's reaction to treatment. 
Describe drainage — amount, color, odor, each 
time bottle is emptied. 

Care of equipment 

1. Wash tubing, drainage bottle, and cap. Boil 

5 minutes. Replace on apparatus. 

2. Wash Levin tube, boil 5 minutes. 

3. Return borrowed equipment to CDR. 

4. Wash metalware, boil 10 minutes. 

5. Return equipment to proper places. 
Precautions. — Do not disturb center bottles of 

apparatus. 

Hand Pump Method 
Equipment: From CDR 

Hand pump apparatus. 
Gallon bottle. 
Two-hole rubber stopper. 
Two pieces 4-foot tubing. 
Connecting tip. 

From ward 

Same as for 3-bottle method. 
To connect apparatus 

1. Connect the two pieces of tubing to the rubber 
stopper. 

2. Insert the rubber stopper into the gallon 
bottle. Be sure the stopper fits tightly. 



NEEDLE VALVE 




Figure 280. — Hand Pump Apparatus. 

3. Connect the free end of one piece of tubing 
to the gage on the tank. 

4. Connect the other piece of tubing to the 
patient's tube. 

To start siphonage 

1. Open needle valve on tank by turning knurled 
knob in a counter clockwise direction. 

2. Create suction in tank by pumping approxi- 
mately 40 to 50 strokes until the gage registers 5. 

If the nasal tube is free from leaks : if the rubber 
stopper in the drainage bottle is free from leaks; 
if the tubing connecting the drainage bottle to 
the tank is free from leaks, this suction should be 
sufficient to last the average patient about 20 hours. 

The care of the patient during treatment is 
similar to the 3-bottle method. Watch gage: dial 
should read 3 to 5 during treatment. 

Improvised (Wangensteen) Three- 

Bottle Method 
Equipment 

Three gallon bottles. 

Three lengths rubber tubing — one ( 6 feet ) : one 
(4 feet); one (3 feet). 

Two 2-hole rubber stoppers to fit bottles. 

Two clamps for tubing. 

Four lengths glass tubing — one (1 foot); two 
(3 inches) ; one (6 inches). 

Bandage or tape for hanging bottle. 

One Levin tube. 

One connecting tip. 

One standard or other apparatus for hanging 
bottle. 

Preparing the equipment 
In utility room 

1. Mark bottles for measuring fluids (see 
simple drainage). 



236 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



2. Insert 1 long and 1 short glass tubing in each 
rubber stopper. 

3. Insert stoppers into 2 bottles. 

4. Set up suction. 

In utility room 

Buttle No. 1. — Fix bandage, or tape to hang on 
hook. Fill to -±,000 cc. with water. Insert stop- 
per with 1-foot glass tubing into bottle. Attach 
6-foot-length rubber tubing to short glass tube. 

Bottle No. £.— Fill with water to 300 cc. Place 
rubber tubing from bottle No. 1 so that end is 
under water. 

Bottle No. 3. — Insert rubber stopper. Attach 4- 
foot tubing to long tube of bottle No. 1, attach 
3-foot tubing to other glass tube. 

Apply clamps. — One to tubing from bottle No. 1 
to No. 3, one to tubing from bottle No. 3 to Levin 
tube. 




At bedside 

1. Place bottles No. 2 and No. 3 on deck. 

2. Be sure all clamps are closed. 

3. Invert and hang bottle No. 1 on standard 21/2 
feet above bed level. 

Starting siphonage 

1. Levin tube is introduced. (See "Intubation 
Technique/') 

2. Connect Levin tube to tube of drainage bottle 
No. 3. 

3. Release clamp on tubing from bottles No. 1 
to No. 2. 

4. Release clamp on tubing of drainage bottle 
No. 3. Care of patient is same as for three-bottle 
method. 

Tube Irrigations 

Indicated : When ordered by the doctor. 
Equipment 19 

1. Basin. 

2. Bulb syringe or 30 cc. Luer syringe. 

3. Curved basin. 

4. Small covered rubber sheet. 

Solution 19 

100° F.-250 to 500 cc. 

Water. 

Normal saline. 

Procedure 

1. Clamp tubing to drainage bottle. 

2. Place covered rubber sheet on bed under con- 
nector of Levin tube and drainage tube. 

3. Place curved basin under connector. 

4. Disconnect tubing. 

5. Fill syringe, insert tip into Levin tube, gently 
inject solution. 

6. Allow solution to drain out of tube into 
curved basin. 

7. Repeat steps 5 and 6 until all solution is used. 

8. Connect Levin tube to drainage tube, un- 
clamp tube. 

9. Remove equipment, measure returned fluid. 

Charting 

Record amount of fluid used, amount returned. 
Note : A glass Y tube may be used in place of the 
connecting tip. Step 4 may then be omitted. 



Figure 281. — Improvised Apparatus. 



19 Solution and equipment must be sterile when used for a patient 
who has had gastric surgery. 



NURSING AND NURSING PROCEDURES 



237 



Gastric Lavage 

Purpose : To empty stomach. 

Indicated: When ordered by the doctor: As a 
preoperative preparation for gastric surgery ; to 
remove poisons. 

Equipment 

Tray containing: 
Stomach tvibe in basin of ice water. 
Two-gallon pitcher of warm water (105° F.), 
or solution ordered by doctor. 
Large pail for returns. 
Rubber sheet and cover. 
Curved basin, paper wipes. 

Procedure 

Preparation of patient and his unit 

1. Screen and tell patient what you are going to 
do. 

2. Place patient in Fowler's position. 

3. Place covered rubber sheet over bedding and 
under patient's chin. 

4. Give patient curved basin and paper wipes to 
hold. 

5. Place pail on deck or bench. 

6. Locate white marker on stomach tube. 

Method 

1. Place tube far back in mouth ; ask patient to 
swallow; each time patient swallows insert tube 
few inches until marker is reached. If patient 
starts coughing, choking, becomes cyanotic — re- 
move tube quickly. Allow patient to rest a few 
minutes. Then re-insert tube. 

2. Invert funnel, allow drainage. 

3. Hold funnel upright, pour solution into fun- 
nel and keep full until approximately 500 cc. has 
been given. 

4. Invert funnel while there is still some solu- 
tion in it, allow to drain. 

5. Repeat steps 3 and 4 until returns are clear 
or until amount ordered has been used. If patient 
becomes exhausted, stop lavage, report to doctor. 

6. Pinch tube at patient's lips, withdraw quickly 
into curved basin. 

7. Make patient comfortable, remove equipment, 
leave unit in order. 

Care of equipment 

1. Measure returns. 

2. Place linen in hamper. 



3. Wash, boil tube 5 minutes. 

4. Wash pail with soap and water, rubbing vigor- 
ously for 2 minutes. 

5. Wash and boil basin and pitcher 10 minutes. 

Charting : Nursing notes 

1. Time — Gastric Lavage — amount of solution 
used. 

2. Amount, appearance, and odor of returns. 

3. Signature. 

If Levin tube is used. Add 50 cc. syringe to 
equipment. Tube may be inserted through nose. 
Plunger of syringe may be used to start or re- 
establish drainage. 

Gastric Gavage 

Purpose: To introduce liquid food or medica- 
tion into the stomach by means of a tube. 

Indicated: When ordered by the doctor for 
patients : Who are unable to swallow ; who are un- 
conscious; who refuse to eat; who have spasm or 
stricture of the esophagus. 

Equipment: To equipment for intubation tech- 
nique add : Fluid to be fed. 

Procedure 

1. Warm liquid food to body temperature. 

2. Follow procedure for intubation technique, 
steps 1 through 6. 

3. Attach ban*el of syringe to tube. 

4. Slowly pour fluid down side of syringe. 
Keep syringe full of fluid until all has been given. 

5. Pour 60 cc. of water into tube after fluid to 
clear tube. 

6. To remove tube. Follow step 8 of intuba- 
tion technique procedure. 

Charting nursing notes: Time; amount and 
name of fluid: state whether tube was introduced 
orally or nasally. 

Evacuative Enema 

Purpose: To remove feces from lower intes- 
tinal tract; to relieve flatulence and abdominal dis- 
tention. 
Cleansing enema — To remove feces : 

1. Soap suds solution (S. S. E.) (White soap) 
500-1.000 cc. 

2. Normal saline solution (N. S.) (1 teaspoon 
salt to 1 pint of water) 500-1,000 cc. 

3. Plain water. 



238 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Carminative enema. — To relieve flatulence and 
abdominal distention : 

1. 1-2-3 enema. 1 ounce magnesium sulphate. 
2 ounces glycerin. 3 ounces water. 

2. Milk and molasses — 6 to 8 ounces of each. 

3. Sodium bicarbonate — 8 grams ( 2 teaspoon- 
fids i to 51 " • cc. hot water. 

Temperature of solution: 105° to 110° F. 

Cleansing Enema 
Tray Containig — 

Irrigating can. 
Rubber tubing. 
(Clamp. 

Glass connecting tip. 
Rectal tube No. 24 French. 
Lubricant (water soluble). 
Curved basin. 
Toilet tissue. 




Figure 282. — Equipment for Cleansing Enema. 



Tongue blade. 
Rubber sheet with cover. 
Pitcher. Covered bedpan and urinal. 
Procedure 

Preparation of patient and unit 

1. Screen patient, explain procedure to him. 

2. Clear the top of bedside locker. 

3. Lower backrest and turn patient on left side 
or side most comfortable for him (Sims position). 
For patients who are paralyzed or unable to re- 
tain any fluids, place the patient on a bedpan be- 
fore injecting fluid. 

Preparation of equipment 

1. Attach rectal tube to glass connecting tip: 
clamp tubing. 

2. Fill pitcher with solution (110° for cleans- 
ing; 105° for carminative). 

3. Pour solution into irrigating can, allow solu- 
tion to run through tubing, clamp. 

4. Remove small amount of lubricant from jar 
with tongue blade and place on piece of toilet 
tissue. 

5. Lubricate rectal tube, leave tissue around 
tube. 

6. Cover bedpan, place tray on top of pan and 
carry to bedside. Carry urinal by handle. 

Method 

1. Place bedpan and urinal on chair, tray on 
bedside table. 

2. Fold back upper bedding in triangle to ex- 
pose anus. 

3. Place covered rubber sheet under patients 
buttocks. 

4. Place curved basin next to anus. 

5. Open clamp on tubing, allow small amount 
of solution to run through tube into curved basin. 

6. Raise upper buttock, locate anus, insert rectal 
tube 3 to 4 inches, hold in place with left hand. 

7. Open clamp with right hand, hold irrigating 
can approximately 18 inches above anus. 

8. Allow solution to flow slowly. 

9. If patient complains of discomfort or 
"cramps," pinch tubing for a few moments. 

10. Continue flow until patient has taken all 
solution or as much as he is able. 

11. Clamp tubing, place can on tray, disconnect 
rectal tube over curved basin. 



NURSING AND NURSING PROCEDURES 



239 




Figure 283. — Administration of Cleansing Enema. 

1-2. Pinch and withdraw rectal tube, place in 
curved basin, remove basin. 

13. Place patient on bedpan : ■ elevate backrest. 

14. Place toilet tissue and call bell within his 
reach. 

15. Carry tray to utility room. Wash your 
hands. 

16. Leave patient alone until he calls, but look 
in on him frequently. 

17. When patient is finished, remove and cover 
bedpan: assist patient with cleansing if ne 
sar; 

Take bedpan to utility room, inspect con- 
tents: note amount, odor, color and consistency, 
unusual appearance. 

19. Take basin of water to patient to wash his 
hands. 

Care of equipment 

1. Rinse irrigating can and tubing with warm 
water. 



"Carminative enema — urge patient to retain solution for 20 
minutes if he is able. When small amount of solution is ordered 
(4-6 oz. i use retention enema equipment. 

a If patient is unable to expel enema, insert rectal tube and 
siphon fluid into bedpan. 



2. Run cold water through rectal tube, wash 
with soap and water: rinse. (Use applicators if 
necessary to clean "eye~ of tube.) 

. Boil irrigating can. curved basin, tubing, and 
rectal tube. 

4. After boiling, immerse rubber goods in cold 
water, dry. hang up to drain. 
S ur metalware. 
Sponge off rubber sheet. 
7 Reset tray. 

Charting: Nursing notes 

1. Time. 

2. Type of enema given. 

3. Results. 

4. Reaction of patient. 
S ...ature. 

Retention Enema 

Purpose: To produce a general systemic effect, 
such as a sedative: to give local remedial effect, to 
soften feces, to relieve irritation. 



-4-8 ounces of warm oil (mineral. 



Types 

1. Oil enema. - 
olive, cottonseed ) . 

. — Dosage mixed with 2 to 3 ounces 
of water, oil. or corn starch solution. 



Example: 

Chloral hydrate 

Paraldehyde [-Dosage as ordered by doctor. 

Sodium bromide.. 



1 




tljwc 284. — Equ ipmen t far Retention 



240 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



3. Cornstarch. — 1 to 6 ounces water; dissolve 
enough starch to make smooth, white fluid. Tem- 
perature of solution 100° F. 

Equipment 

Tray. 

Pitcher. 

Funnel. 

Rectal tube French 20 or catheter. 

Lubricant. 

Tongue blade. 

Toilet tissue. 

Covered rubber sheet. 

Procedure 

Preparation of patient and unit 

1. Screen patient, tell him what you are going 
to do. 

2. Clear top of bedside locker. 

3. Turn patient on either side (most comforta- 
ble position for him). 

4. Place covered rubber sheet under patient's 
buttock. 

Preparation of equipment 

1. Prepare solution ordered at correct tempera- 
ture. 

2. Put lubricant on toilet tissue and lubricate 
rectal tube. 

3. Attach rectal tube to funnel. Place in curved 
basin. 

4. Take tray to bedside. 

Method 

1. Expose anal area by forming triangle of 
upper bedding. Place curved basin next to anus. 

2. Fill funnel with solution, allow solution to 
flow through tube back into pitcher, pinch tubing 
before funnel is empty. 

3. Holding funnel in one hand, raise upper but- 
tock and insert rectal tube about 4 inches. 

4. Raise funnel even with top of buttock. Allow 
solution to flow slowly, 22 keep funnel full until all 
solution has been given. 

5. Pinch tube — remove and place in curved 
basin — disconnect funnel and tube. Place basin 
on tray. 




22 Solution must be given very slowly to avoid stimulating 
bowel movement. If patient has difficulty retaining solution, 
apply gentle pressure with toilet tissue to rectum until desire to 
ate has passed. 



Figure 285. — Administration for Retention Enema. 

6. Leave patient on his side, do not disturb him. 

7. Take equipment to utility room. 

Care of equipment: Same as for evacuative 
enema. 

Charting : Nursing notes 

1. Time. 

2. Type and amount of solution. 

3. Whether or not solution was retained. 

4. Signature. 

Colostomy Irrigation 

Purpose: To remove feces from the large in- 
testine. 

Equipment: Same as for cleansing enema ex- 
cept : 

1. Use smaller tube, 18-22 French catheter or 
rectal tube. 

2. 500 to 750 cc. normal saline or water at 
100° F. 

3. Add dressing tray and curved basin. 

Preparation and after care of equipment. — 

Same as for a cleansing enema. 

Procedure 

1. Screen patient, tell him what you are going 
to do. 

2. Turn the patient on the side of the colostomy. 

3. Place a covered rubber sheet on the bed under 
the colostomy. 

4. Remove the dressing; place it in the curved 
basin. 

5. Place the second curved basin under the 
colostomy opening. 



NURSING AND NURSING PROCEDURES 



241 



6. Introduce lubricated catheter about 4 inches 
into the colostomy, hold the tube in place with the 
left hand. 

7. Raise irrigating can 10 inches above the 
colostomy. 

8. Allow solution to flow slowly until all has 
been given, then pinch and remove the tube. 

9. Leave curved basin in place until return flow 
stops. 

10. Open dressing tray, clean wound with soap 
solution, apply dressing. 



11. Make patient comfortable; leave unit clean 
and in order. 

Note. — Bo gentle and tactful with this patient, particu- 
larly if the colostomy is a recent one. lie has to become 
accustomed to this new situation in which he ha-- oo 
control of his bowel movements and he has fears of pos- 
sibly offending and embarrassing himself and others 
Reassure and encourage him. The colostomy can he regu- 
lated in almost the same way as the rectum hut it takes 
time, patience, attention to diet, and the complete coopera- 
tion of the patient and all personnel. 



PROCEDURES RELATING TO THE GENITOURINARY TRACT 

Review — Chapter II, "The Excretory System" 

"The Reproductive System" 

Chapter VII, "Drugs Which Act On the Urinary System" 



The treatments relating to the genitourinary 
tract are prescribed in order to cleanse the area, 
apply heat, to administer medications or to re- 
move fluid. All treatments requiring the inser- 
tion of any instrument into the urinary bladder 
must be executed using sterile technique. The 
corpsman is urged to obtain supervision when 
doing these treatments because of the danger of 
infection due to faulty aseptic technique or the 
danger of producing injury due to improper inser- 
tion of catheters. 

The treatments discussed in this section are lim- 
ited to those a corpsman would be likely to be 
called upon to do in a ward or sick bay. Other 
special genitourinary treatments are given in the 
G. U. clinic by the doctor or a trained technician. 

Catheterization 

Purpose : To remove urine from the bladder by 
means of a catheter introduced through the ure- 
thra. 

Indicated : When ordered by the doctor : To re- 
lieve retention of urine; before certain operations; 
to collect a sterile specimen of urine. 

Equipment 

Sterile 

One pair rubber gloves. 

Two solution cups. 

Two catheters Xos. 14, 16, 18 French. 

One curved basin. 



Six gauze sponges or cotton balls. 

Two 4x4 gauze flats. 

One sterile towel. 

One forceps or hemostat. 

One specimen bottle. 

Unsterile 
One small rubber sheet and cover. 
One curved basin. 
One urinal. 

Procedure 

In utility room, 

1. Wash your hands! 
•2. Open sterile tray. 

3. Fill solution cups. 

4. Place small amount of lubricating jelly on a 
4x4 gauze flat. 

5. Cover tray, take to bedside with the rest of 
the equipment. 

At bedside. Male patient. 

1. Screen patient and tell him what you are 
going to do. Ask him to place his hands under 
his head and keep them there. Position — dorsal 
recumbent. 

2. Fan-fold top bedding to patient's knees. 
Cover his chest with an extra sheet if ward is cool. 

3. Place covered rubber sheet over thighs and 
under penis. 

4. Place unsterile basin on covered rubber sheet. 



242 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



5. Place tray on bedside locker. Open tray. 

6. Hold penis just back of head of penis, retract 
foreskin if possible. 

7. Scrub the head of the penis with three soap 
solution cotton balls and discard cotton balls into 
unsterile basin. 

8. With forceps, remove soap with three boric 
acid solution cotton balls. 

9. Remove unsterile basin. Open sterile towel, 
place on rubber sheet, place cleansed penis on ster- 
ile towel. 

10. Put on sterile rubber gloves. 

11. Place sterile curved basin on towel. 

12. Pick up catheter, lubricate tip with jelly, 
hold other end between third and fourth finger. 

13. Hold penis at 60° angle, with other hand. 



'■— May be slight resistance 




Considerable resistance may ^Enlarged prostate may cause 
be met at sphincter. Apply obstruction here. If unable to 

steady gentle pressure. pass catheter with steady gentle 

pressure remove catheter, report 

to WMO stat. 

Figure 286. — Insertion of Catheter. 

14. Insert catheter until resistance is felt, apply 
steady gentle pressure, lower penis and continue 
insertion until urine begins to flow, place end of 
catheter in sterile basin. 

15. If specimen is to be obtained, collect 120 cc. 
in specimen bottle. 

16. When urine ceases to flow, pinch catheter and 
remove it quickly and gently. 

17. Leave patient dry, covered, and comfort- 
able. 

18. Remove equipment. Measure amount, note 
color, appearance and odor of urine. 

19. Cover sterile specimen with sterile -t x 4's 
held in place by elastic band. 

20. Clean, sterilize, and store equipment. 



At bedside. Female patient. Same purpose, 
equipment and preparation of equipment, add 
1 sheet and drop light. 

1. Screen patient, tell her what you are going 
to do. 

2. Drape sheet diagonally over patient. Fan- 
fold bedding to foot of bed. 

3. Draping: Fold back corner (2) to groin. 
Wrap corners (3) and (-1) around patient's right 
and left feet, leaving the genital area exposed. 




Figure 287. — Draping the Patient. 

4. Place a covered rubber sheet under patient's 
buttocks. 

5. Place tray on bed between patient's legs, un- 
sterile basin to one side of tray, place droplight to 
give best light. 

6. Open tray, fold back tray cover to patient's 
buttocks. 

7. Put on sterile gloves. 

8. Separate labia, with left hand. Pick up for- 
ceps in right hand. 

9. Cleanse labia, urinary meatus, perineum with 
cotton balls of soap solution. Follow with boric 



NURSING AND NURSING PROCEDURES 



243 



Clitoris 





Indwelling or Retention Catheter 

The doctor inserts a retention catheter. The 

COrpsman is responsible for the preparation of the 
patient and equipment and for keeping a record of 
intake and output. 

Purpose: To provide constant drainage of uri- 
nary bladder. 

Indicated: When ordered by doctor for pa- 
tient — following surgery, when patient is inconti- 
nent of urine, or is having difficulty in voiding. 

Types of Catheters Used 

Mushroom.— Has small bulb near tip. The 
catheter is stretched over a metal director and in- 
serted. When director is removed, small bulb re- 
forms in bladder, holding catheter in place. 



(a) 



Figure 288. — Female Genitalia. 



(b) 



acid solution. Use each cotton ball once, always 
wiping from labia to perineum and off. Discard 
cotton into unsterile basin. 

10. Place sterile basin close to buttocks. 

11. Pick up catheter, lubricate tip, hold other 
end of catheter between third and fourth fingers. 

12. With other hand separate labia, locate 
meatus. 

13. Insert catheter gently until urine begins to 
flow (li/o to 2 inches). Place end of catheter in 
basin. 

14. If specimen is to be obtained, collect about 
120 cc. directly into specimen bottle. 

15? Pinch and remove catheter when urine flow 
stops. 

16. Leave patient dry, covered, and comfortable. 

17. Clean, sterilize, and store equipment. 

Charting — Nursing notes 

1. Time. 

2. Treatment. 

3. Amount, color, appearance, and odor of urine 
obtained. 

4. Complaints of patient. 

5. State if specimen was obtained. 

6. Signature. 



(c) 



-J3 



(d) 

Figure 289. — A — Catheter Director; B — Mushroom Catheter; C — 
Foley Catheter; D — French Catheter. 

Foley. — Double lumen catheter; one opening is 
for drainage, other opening is to small balloon at 
tip of catheter which is inflated with 4 cc. sterile 
water after it is inserted into bladder. Screw 
clamp is then applied to this opening and is not 
released until catheter is to be removed. 

French. — This is a straight catheter. It is fas- 
tened by placing adhesive tape along one side of 
the shaft of the penis, wrapped about the catheter, 
and fastened on the other side of the penis. Two 
strips of adhesive are then placed around the shaft 
of the penis in the manner illustrated (fig. 290). 




Figure 290. — Retention Catheter in Place. 



244 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Equipment 

All equipment for catheterization, plus: 

1. For Foley catheter. 
Sterile catheter. 
Sterile solution basin. 
Sterile water. 
Sterile 10 cc. syringe. 
Screw clamp. 

2. For Mushroom catheter. 
Sterile catheter. 
Sterile metal director. 

3. Sterile drainage tubing and connecting tip. 

4. Gallon drainage bottle. 

5. Rubber band and safety pin. 

6. Adhesive tape. 

7. Bandage. 

Procedure 

1. Follow procedure for catheterization. 

2. Connect catheter to drainage. See "Simple 
drainage." 

Bladder Irrigation 

Purpose: To wash out the urinary bladder. 

Indicated : When ordered by the doctor to 
cleanse the area of sediment, bacteria and their 
products, pus and excess mucus ; to relieve inflam- 
mation; to control bleeding. 

Method I. — Following catheterization 

Equipment 

1. Same as for catheterization, plus: 
Sterile Pitcher, 
bulb syringe or glass funnel, 
solution — may be boric acid 4 percent. 
Temperature of solution 100° F. 
Amount — as ordered by doctor, 250 to 500 cc. 

Procedure 

1. Follow catherization procedure; do not re- 
move catheter. 

2. Attach glass portion of asepto syringe or 
glass funnel to catheter. 

3. Place curved basin under funnel, pour solu- 
tion slowly along side of the syringe or funnel. 

4. Invert syringe or funnel and allow solution 
to drain into curved basin. 



5. Repeat steps 3 and 4 until all solution has 
been used. 

6. Follow catheterization procedure for remov- 
ing catheter, care of patient and equipment. 

Method II. — Intermittent irrigation — indwell- 
ing catheter in place. 

1. Add small covered rubber sheet to equip- 
ment. 

2. Place covered rubber sheet under connecting 
tip of catheter and drainage tubing. 

3. Place, curved basin on rubber sheet. 

4. Disconnect tubing and catheter. 

5. Attach glass portion of syringe or funnel to 
catheter. 

6. Do steps 3, 4 and 5 of method I. 

7. Connect tubing and catheter. 

8. Remove equipment, straighten bedding, leave 
patient comfortable. 

9. Measure and chart returns — its color, is there 
mucus or pus? Is it cloudy or bloody? What 
was the effect on the patient ? 

10. Place linen in hamper. Wash, boil and 
store equipment. 

Method III. — Continuous irrigation 

Equipment — sterile 

1,000 cc. solution in sterile bottle. 

Rubber tubing, one 4-foot length, one 2-foot 
length, and one l^-foot length. 

Connecting tips, one Y tube, one straight tube. 

Gallon bottle. 

Two-hole rubber stopper with two short pieces 
of glass tubing. 

Murphy drip regulator. 

Equipment — unsterile 

Standard. 

Elastic band and safety pin. 

Two screw clamps. 

Procedure — Preparation of equipment 

1. Insert two hole stopper into gallon bottle. 

2. Place one clamp on iy 2 -foot tubing. Close 
clamp. 

3. Connect 4-foot tubing to bottle and 1 prong 
of Y tube. Insert drip regulator just below 
bottle. 

4. Connect 2-foot rubber tubing to drainage 
bottle and other prong of Y tube. 



NURSING AND NURSING PROCEDURES 



245 




Figure 291. — Bladder Irrigation. 

5. Connect l^-foot tubing to straight of Y tube. 

6. Hang bottle on standard. Release clamp on 
4-foot tube. Allow solution to run through tub- 
Close clamp. 



ing until all air is removed 



Method 

1. Explain procedure to the patient. 

2. Attach li/^-foot tubing to patient's catheter 
with straight connecting tip. Open clamp, allow 
urine to flow into drainage bottle. 



3. Loop elastic hand around Y tube and pin to 
patient's drawsheet. 

4. To irrigate the bladder: 
Pinch off outflow tube by hand. 

Release clamp on inflow tube, allow 50 cc. of 
solution to flow into bladder. Close clamp. 
Release outflow tube. 

5. Step 4 is repeated as ordered by the doctor. 
With the doctor's permission, the patient may be 
taught to do step 4 himself. 

Charting nursing notes 

Time treatment started. 

Amount, name, strength, and temperature of 
solution used. 

Description of the returns. 
Patient's reaction to treatment. 
Signature. 

Precautions 

1. All connections must be handled without con- 
tamination. 

2. Solution bottle must be kept filled. 

3. Control the speed of inflow by adjusting the 
screw clamp on inflow tube. 

4. Keep accurate intake and output records. 

5. If Kelly flask is used for solution, the top 
must be kept covered with sterile 4 x 4's. 

Bladder Instillation 

Purpose: To treat the bladder with an anti- 
septic solution. 
Equipment: Catheterization tray, plus — 

Medication in sterile container. 

Sterile syringe. 

Procedure 

1. Follow procedure for catheterization through 
to removal of urine. 

2. Attach syringe to catheter. 

3. Pour medication into syringe. 

4. When all medication has passed through 
catheter, pinch and remove catheter. 

5. Proceed as in catheterization. 

Note. — Bladder irrigation and instillation are often 
ordered for the patient following catheterization. 

Simple Drainage 

Purpose : To provide for removal of fluids from 
wound or body cavity. 



211866° — 53- 



-17 



246 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Indicated : When drainage is desired from 
wound, from urinary bladder, or from other body 
cavity. 

Equipment 

Gallon bottle, 2-inch adhesive tape, and ink or 
colored pencil for marking bottle. 
Glass connecting tip. 
Rubber tubing, 3-foot length. 
Safety pin. 
Elastic band. 
Two-inch bandage. 
Graduate. 

Procedure 

Preparation of equipment 

Provide for measuring fluid (fig. 292). 

1. Place adhesive tape on side of bottle. 

2. Pour 500 cc. water into bottle. Mark water 
level with ink or colored pencil. 

3. Continue step 2 until 4,000 cc. is reached 
and marked. 

4. Divide each space between marks evenly 
with four short lines. Bottle is now graded at 
100 cc. levels. Empty bottle. 

Attach connecting tip to tubing; place other end 
of tubing in bottle. 

Preparation of patient 

1. Attach connecting tip to catheter from 
wound or bladder. 

2. Tie drainage bottle to lower bar of bed at 
side. 

3. Loop rubber band around rubber tubing, pin 
to bedding. Rubber tubing should be long enough 
to allow patient to move freely in bed. 




Figure 292. — Marking trfe Measurement of a Bottle. 

During treatment 

1. Watch drainage, check amount, color, ap- 
pearance, and odor. 

2. Empty drainage bottle every 24 hours. 

a. Measure and record amount. 

b. Wash bottle with cold water, warm soapy 
water, rinse and dry. 

After treatment 

1. Wash and boil equipment. 

2. Return equipment to proper place. 



NURSING AND NURSING PROCEDURES 



247 



PROCEDURES RELATING TO THE EYE, EAR, NOSE, AND THROAT 

Review — Chapter II, "The Respiratory System" 

"Special Senses" 



Treatments of the eye, ear, nose, and throat are 
usually given to administer heat or cold to the 
area (compresses) ; wash away discharges (irriga- 
tions) ; or to apply medication (drops). 

The treatments of the eye which involve direct 
application to the eye itself require surgical asep- 
tic (sterile) technique. Other procedures are 
clean treatments. The corpsman should be very 
gentle when performing these treatments for his 
patients. Carelessness of the corpsman may re- 
sult in blindness, deafness, or severe infection to 
the patient. 

Charting of eye, ear, nose, and throat treat- 
ments. — Time treatment was given; amount, 
name, strength, and temperature of the solution 
used ; name of the part treated ; the results of the 
treatment; if irrigation, describe the returns; the 
reactions of the patient to the treatment. 

EYE TREATMENTS 

Instillation of Eye Drops 

Purpose : To relieve pain. To prepare for ex- 
amination. To anesthetize preoperatively. 

Equipment 

1. Sterile medicine dropper in tube. 

2. Fresh medication specially prepared for use 
in eye. 

3. Clean basin containing sterile water, normal 
saline, or boric acid solution 2 percent at 100° F. 
to cleanse eyelids of discharges. 

4. Clean cotton balls. 

5. Curved basin. Paper wipes. 

Precautions 

1. Use only fresh, sterile medication specially 
prepared for eye use. Check dates on labels of 
eye medications. 

2. Read medication label three times. 

3. Use sterile medicine dropper. 

4. Do not use dry cotton on eye. 

5. Wash your hands before all treatments. 
When no discharge is present, cleansing equip- 
ment and step 1 of the procedure may be omitted. 



Procedure 

1. Moisten cotton ball, cleanse discharge from 
lids. Wipe from inner to outer side — use new 
cotton ball for each stroke. 

2. Draw medication up into dropper, hold drop- 
per upright so medicine does not enter bulb. 

3. With dropper in one hand, take paper wipe 
in other and gently draw down lower lid by 
placing first two fingers on cheek. 

4. Ask patient to look up. 




Figure 293. — Instillation of Eye Drops. 

5. Drop prescribed number of drops into pocket 
formed by lower lid. Hold dropper parallel to 
eye. Rest your hand on patient's forehead. 

6. Have patient gently close eyes; hold wipe at 
inner comer of eye. 

Application of Eye Ointment 

Purpose: To treat infection, to dilate or con- 
tract pupil, to lubricate the eye. 

Precaution: Hold ointment tube parallel to 
eye. 

Procedure 

1. Draw down lower lid by placing first two 
fingers on cheek. 

2. Apply ointment along rim of lower lid. 

3. Have patient close eyes. 

4. Massage only if ordered. 



248 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 294. — Application of Ointment to Eye. 

Eye Irrigation 

Purpose : To remove discharges ; provide moist 
heat; remove foreign body. 

Equipment 

Sterile 

Tray with following: 
Solution basin. 

Solution 105° F. (may be water, normal 
saline, boric acid 2 percent) 30 to 90 cc. 
30 cc. asepto syringe or medicine dropper. 
Clean (for cleansing eye lids) 
Cotton balls. 
Basin of water. 




Curved basin. 
Face towel. 

Precautions : When both eyes are affected, use 
separate equipment for each eye, wash hands thor- 
oughly between treatments of eyes. 

Procedure 

1. Place towel over shoulders. 

2. With moistened cotton ball, cleanse discharge 
from eye. 

3. Fill asepto syringe, expel air. 

4. Separate eye lids, direct flow from inner to 
outer canthus. Use only sufficient force to cause 
continous flow of solution. 

5. Continue steps 3 and 4 until all solution is 
used. 

6. Wipe cheek with towel. 

Eye Compresses 

See applications of heat and cold, pages 227-231. 

EAR TREATMENTS 

Installation of Ear Drops 

Purpose: To soften wax; to relieve pain; to 
shrink foreign body. 

Equipment 

1. Clean medicine dropper. 

2. Bottle of medication in basin of warm water. 

3. Cotton applicators. 

4. Paper bag for waste. 




Figure 295. — Eye Irrigation. 



Figure 296. — Instillation of Ear Drops. 



NURSING AND NURSING PROCEDURES 



249 



Precautions 

1. Solution must be warm. 

2. Do not use force in cleansing ear. 

Procedure 

"Wash your hands ! 

1. Turn patient on his side with ear to be treated 
uppermost. 

2. Cleanse outer ear and entrance to canal with 
applicator. 

3. Draw warm medication up into dropper. 

4. Instill number of drops ordered. 

5. Have patient remain in position for 15 
minutes. 

6. Do not place cotton in ears unless ordered. 
When ordered, place piece loosely in outer ear. 

Ear Irrigation 

Purpose: To apply moist heat; to wash out 
discharges. 

Equipment: Tray containing — 

Rubber ear syringe or 1 ounce asepto syringe. 

Curved basin. 

Basin of solution (250 cc. at 105° F.). 

Solution may be water, normal saline or boric 
acid solution. 

Rubber sheet and cover. 

Procedure 

1. Drape covered rubber sheet over patient's 
shoulder. 




2. Place curved basin under ear, have patient 
hold it if he is able. 

3. Cleanse discharge from ear. 

4. Fill syringe, press bulb until solution appears 
at tip of syringe. 

5. Tilt patient's head over basin. 

6. Straighten ear canal. Adult — draw ear up 
and back; child — draw ear down and back. 

7. Direct flow toward side of canal; use only 
enough force to produce a steadj' stream. 

8. Use all solution. Dry ear when finished. 

NASAL TREATMENTS 

Instillation of Nose Drops 

Purpose: To relieve inflammation and conges- 
tion of nasal passages. 

Equipment: Medicine dropper; solution. 







Figure 297. — Ear Irrigation. 



Figure 298. — Instillation of Nose Drops. 

Procedure 

1. Place patient in a sitting position with head 
back, or lying flat in bed, a pillow under shoul- 
ders and head tipped to the side. 

2. Instill number of drops ordered. 

3. Have patient hold position for 5 minutes. 

Nasal Spray 

Equipment: Atomizer with solution ordered. 

Procedure 

1. Remove air from atomizer by squeezing bulb 
until spray is visible. 

2. Tell patient to inhale while spray is being ap- 
plied. Hold atomizer so that nasal tip is at nos- 
tril. 

3. Spray each nostril. 



250 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 299. — Nasal Spray. 

THROAT TREATMENTS 

Throat Spray 

Same as for nasal spray except nasal tip is re- 
moved. 




Figure 300. — Throat Spray. 

Throat Irrigation 

Throat irrigation to be effective depends upon 
heat of solution, direction of solution to affected 
part and mechanical washing by the solution. For 
these reasons the patient should hold the irrigating 
tip and direct the flow. The solution should be as 
hot as he is able to take it unless a specific tempera- 
ture is ordered by the doctor. 




Figure 301. — Throat Irrigation. 

Purpose: To relieve inflammation; to remove 
secretion; to apply moist heat to mucous mem- 
branes of throat. 

Equipment 

Tray with — 

1. Irrigating can, with 3 foot tubing. 

2. Glass connecting tip. 

3. Stopcock. 

4. Rubber tubing, 6 inches. 

5. Basin. 

6. Towel. 

7. Pitcher of water, normal saline or 2 percent 
soda bicarbonate solution at 110° to 115° F. 

8. Rubber sheet. 

9. Paper wipes. 

10. Curved basin. 

Preparation of patient and equipment 

1. Place patient in sitting position or turned on 
his side. 

2. Place covered rubber sheet over chest and pin 
around his neck. (Pin through cover.) 

3. Place basin in front of patient. 

4. Connect irrigating can tubing to glass and 6 
inch rubber tip. Close stopcock. 

5. Fill irrigating can with solution. Open 
clamp, allow small amount of solution to run 
through tubing; clamp. 

6. Instruct patient to hold head to one side, to 
breathe through his nose, to direct flow toward 
painful areas; to take frequent rest periods and 
not to swallow while solution is flowing. 



NURSING AND NURSING PROCEDURES 



251 



Procedure 

1. Give patient irrigating tip. 

2. Raise can to 12 inches above patient's mouth, 
open clamp. 

3. Watch patient, pinch tubing when he stops to 
rest. 



4. When all solution is used — disconnect tubing 
at glass tip. 

5. Place tip in curved basin. 

6. Remove all equipment, leave patient clean 
and comfortable. 



SURGICAL DRESSINGS 

Review — Chapter III, "Wounds" 

"Bandages and Bandaging" 

Chapter VII, "The Antiseptics" 



A surgical dressing has two meanings : (1) The 
act of covering a wound with material made of 
gauze and/or cotton; (2) the act of removing a 
dressing, treating a wound and applying a fresh 
dressing. 

Purposes: To protect the wound from injury 
or infection ; to absorb drainage : to inspect and/or 
treat a wound. 

Indicated: Whenever ordered by the doctor. 

Corpsman's duties in surgical dressings 

1. To prepare the patient and his unit. 

2. To prepare and assemble the necessary equip- 
ment. 

3. To assist the doctor as required. 

4. To do the dressings as required. 

Rules To Observe When Handling Sterile 
Equipment 

The following rules are based on the major prin- 
ciple of surgical aseptic technique which is: All 
articles coming in direct or indirect contact with 
a wound must be sterile. 

1. An article is either sterile or unsterile. There 
is no in-between. If any doubt exists, consider 
it unsterile. 

2. Sterile articles must be kept covered until 
ready for use. 

3. Only the outside of the wrapper or cover is 
touched when opening a sterile package or con- 
tainer. 

4. A sterile article is handled with a sterile in- 
strument or sterile gloves. 

5. Once an article is removed from a sterile 
container it is not returned to that container. 



6. When lifting a sterile basin, slide hands 
under the basin. 

7. When removing an article from a sterile 
container. 




4fc3» 




Lift forceps stroight 
up — Do not touch 
sides of container 



Figure 302. — Tech- 
nique Forceps. 



Figure 303. — Removing Article from 
Sterile Container. 



Use technique forceps. Only that part of the 
container and that part of the forceps covered by 
the disinfecting solution may be considered 
sterile. Always hold tip of forceps pointing 
downward. 



252 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Remove the cover of the container. Hold the 
cover in one hand. Remove the article with the 
technique forceps in the other hand. Replace 
the cover. (If it is necessary to put down the 
cover, place it upside down on a flat surface.) 

Replace forceps in its container — straight 
down and in. 

8. When a container becomes contaminated, re- 
move it at once. If it is not possible to do so 
immediately, invert the cover on the container to 
signify its contamination. 

9. Avoid reaching over a sterile field. 

10. Edges of sterile towels are considered un- 
sterile after contact with an unsterile surface. 

11. Keep instrument handles out of sterile field. 

12. Pour sterile solutions without contact be- 
tween the bottle and sponge or container. 

THE DRESSING CARRIAGE 

The dressing carriage serves as a portable sup- 
ply table containing all the sterile and clean ar- 
ticles necessary for changing a series of dressings. 
The amount and type of supplies needed will vary 
according to the type of ward and the number of 
patients being served. 

Equipment on the Dressing Carriage 
Top shelf 

1. Sterile containers holding: 
4x4 gauze flats. 
2x2 gauze flats. 




Figure 304. — The Dressing Carriage. 



Towels or field cloths. 
Tongue blades. 
Applicators. 
Safety pins. 
Instruments. 

2. Two technique forceps in separate containers 
three-fourths full of disinfectant solution. 

3. Solutions and ointments as required for the 
ward. 

Bottom shelf 

1. Sterile packages of : 
Abdominal pads. 
Towels. 

Gloves (assorted sizes). 
Culture tubes, packing, slides, etc., as re- 
quired for the ward. 

2. Clean supplies : 
Curved basins. 
Paper bags. 

Tray for clean, unused dressings. 
Bandage (assorted sizes). 
Metal container of soap solution for soiled 
instruments. 

3. Attached to bars of dressing carriage : 
Roller of adhesive tape (assorted sizes). 
Bandage scissors. 

Paper bag for used gloves and soiled towels. 

4. Bucket for wastes : Line bucket with a large 
paper bag or several thicknesses of newspaper. 

Note. — Where possible the use of individual autoclaved 
dressing trays from CDR is recommended. These trays 
may be ordered with the other supplies in the morning 
and stored on carriage until used. 

Care of the Dressing Carriage 
Daily 

1. Clean and reset carriage : 

Remove all the equipment from the carriage. 
Clean and boil technique forceps, instruments, 
and their containers. 

Return other containers to CDR for new 
supply. 

Wash down the entire carriage. 
Reset carriage. 

Fill the technique forceps container three- 
fourths full of disinfectant solution. 
Replace equipment as listed. 
Check carriage for completeness. 



NURSING AND NURSING PROCEDURES 



253 



After dressings are completed 

1. Clean soiled instruments, boil and replace on 
tray. 

2. Remove soiled dressings, place in burnable 
trash can. 

3. Replenish other supplies as needed. 
Weekly 

1. Check the date on all sterile packages. 

2. Return outdated articles to CDR. 

3. Return articles not in current use to CDR. 

Changing or Assisting With Dressings 

Types of wounds to be dressed 

Clean wounds are those made under aseptic 
conditions. These are usually closed wounds 
that heal by primary intention without infec- 
tion. 

Dirty or contaminated wounds are those 
which are infected or possibly infected. Dirty 
wounds are usually open, draining wounds that 
heal by secondary intention. Rectal and in- 
testinal wounds are usually considered dirty be- 
cause of the contamination by fecal material. 

To change a dressing 

Procedure 

Wash your hands ! 

1. Bring dressing carriage to patient's bed- 
side. 

2. Screen patient. Explain procedure. Ask 
him to put his hands under his head and keep 
them there until the dressing is completed to 
avoid contaminating sterile field. 

3. Fold back bedclothes to expose the area to 
be dressed. 

4. Place dressing basin (lined with paper 
bag) on the bed to receive soiled dressings. 

5. Loosen patient's dressing. To remove ad- 
hesive : press skin taut under adhesive with one 
hand; with other pull tape toward wound. 

6. Set up sterile field, using the technique for- 
ceps to remove sterile articles from their sterile 
containers : 

Set up sterile field, using the technic forceps 
to remove sterile articles from their sterile con- 
tainers : 

Sterile towel, open to two thicknesses, place 

on patient's bed near dressing or on patient's 

bedside table. 




Figure 305. — Removing Adhesive. 

Sterile 4x4 and 2x2 gauze sponges for 
dressing. Use judgment in setting out these 
supplies. (3 to 6 4 x 4's are all that are re- 
quired for most dressings.) 

Thumb forceps and hemostat. Place in- 
struments so that the handles are over the edge 
of the towel. 

7. Remove the outer dressing, inspect it, and 
place it in the dressing basin. 

8. Pick up the thumb forceps, remove the 
inner dressings carefully so as not to remove a 
drain or tube if present ; inspect the dressing. 
Drop into dressing basin. 

9. Clean wound : 

Pick up a sponge with the hemostat. 
Pour solution to be used over the sponge. 





Figure 306. — Removing Inner Dressing. 



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HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 307. — Cleaning a Wound. 

Clean incision line using rotary motion. 
Discard sponge. Repeat with additional 
sponges cleaning around the wound. 

Inspect the wound. Any swelling, red- 
ness or discharge? Does the patient com- 
plain of tenderness or pain ? 

10. Open fold of 4 x 4's with hemostat and 
apply to wound. 

11. Apply sterile pad if needed. 

12. Cut strips of adhesive tape to tit patient. 
Apply adhesive tape. Secure tape on far side 

of dressing, pull snugly, fasten on near side. 

13. Remove soiled dressings, place in bucket 
on carriage. 




Figure 308. — Applying Sterile Dressing. 



14. Place instruments in container of soap 
solution. 

15. Place clean towel and unused dressings in 
tray on bottom shelf of carriage. 

16. Make your patient comfortable, square 
away his unit. 

17. Wash your hands. 

To use vaseline gauze 

1. Using technique forceps, remove a thumb for- 
ceps by the points from the instrument tray. 
Place handle of thumb forceps in doctor's hand. 
Replace technique forceps. 

2. Remove cover from container of vaseline 
gauze. Doctor will remove the number of strips 
he needs and drop them on the patient's sterile 
field. Replace cover of container. 

3. Using two forceps, the doctor will place the 
gauze as he wishes. 

To remove sutures or clips 

1. Add scissors to equipment. 

2. Follow steps of "To Change a Dressing." 

3. Paint suture line with Tr. of Merthiolate or 
solution ordered by the doctor. 

4. Slip scissors under suture and clip close to 
the skin. 

5. With thumb forceps, grasp suture knot and 
remove. Place suture on a 4 x 4. When all su- 
tures are removed place gauze and sutures in dress- 
ing basin. 

6. Clean incision with alcohol. 

7. Proceed as for changing a dressing. 

8. Clips are removed in the same manner using 
a clip remover instead of scissors. 

Assisting the doctor with dressings 
Preparation : 

Check with the doctor; list all patients who 
are to be dressed. 

Check the carriage. Keep enough supplies 
on hand to do these dressings. 

Is there a need for any special equipment? 
Have a plan for dressings. 
Do clean, closed wounds first. 
Do clean, open wounds next. 
Do dirty or infected wounds last. 
Inform those patients who are to be dressed. 



NURSING AND NURSING PROCEDURES 



255 



Procedure 

Follow steps of "To Change a Dressing.'' 
Doctor will clean and inspect wound. Pay 
strict attention to the progress of the dressing; 
anticipate the doctor's needs. 

He will follow the same general outline as 
described in "To Change a Dressing." 
Charting on the nursing notes includes : Time, 
type of dressing, location of wound, solution used, 
condition of the wound, signature. 

Attachment of Dressings 
Dressings are held in place by 

Adhesive tape: 

Strips — straight pieces of tape of varying 
widths hold dressings in place and provide sup- 
port to the wound. 

Montgomery straps — a tie strap used when 
dressing must be changed frequently. 

1. To make — cut adhesive of the desired 
width in 6-10 inch strips, number and length 
depending upon the size of the dressing to be 
held in place. Fold 2 inches of strip back on 
itself. Puncture or cut a small hole in this 
fold. 

To apply strips. Place smooth side of strip 
on dressing, then fasten adhesive side to pa- 
tient. Repeat with other strips. Thread 
bandage through holes in strips, tie in center. 
Elastic bands are sometimes used. Insert an 
applicator stick slightly wider than the ad- 
hesive strip and fold strip back on itself. This 
type of dressing attachment is useful in chest 
dressings since it permits the dressing to 
"give" when patient inhales. 
Butterfly. — A small piece of tape used to 
bring skin edges together. The adhesive must 
be flamed when used over wound. 

1. To make— cut a 4 inch length of 1 inch 
adhesive, fold adhesive tape lengthwise, cloth 
sides together. Narrow strip in the center 
by cutting out small piece: 

2. To apply — light the alcohol lamp. Pass 
the tape back and forth through the flame of 
the lamp, cloth side clown, until the plaster 
bubbles. Allow the plaster to cool. Attach 




Figure 310. — Flaming 
Adhesive. 



Figure 309. — Montgomery Straps. 

tape to one side of the wound, press edges of 
wound together, attach tape on other side of 
the wound. 
Cellulose tape. — This tape is used for small 
dressings, particularly for eye and face dressings. 
Liquid adhesive or collodion.— is used for small 
dressings, particularly scalp dressings. 
Bandage. — See First Aid Section. 

Application of Binders 

A binder is a wide bandage or piece of cloth 
used to protect and to hold a dressing in place, to 
apply pressure, to give support, and to add to the 
patient's comfort. 

Tailed — many tailed (scultetus) for abdominal 
or chest dressings. (T or double T — for perineal 
or rectal dressings.) 




Figure 311. — Applying a Scultetus Binder. 



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HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Straight — for chest or abdominal dressings. 
When applying binders : Be sure binder is smooth 
under the patient; insert pins at right angles to 
the pull of the material ; avoid placing pins over 
bony prominences or areas that may cause pressure. 

Many tailed 

Place binder under patient. 
Starting at lowest tail, lap tail one over the other 
to the top. Pin in place. 

T Binder (female patients) 

Place the cross bar of the T around the patient's 
waist. 

Bring long bar of the T around perineum to 
cross bar in front. Pin with safety pin. 

Double T Binder (male patients) 

Place the cross bar of the T around the patient's 
waist. 

Bring double strips of T around perineum, each 
side of scrotum to cross bar in front. Pin with 
safety pin. 

Wound Irrigations 

Purpose: To wash out a wound; to remove 
debris, pus. 



Equipment 

1. Sterile solution basin. 

2. Amount of sterile solution ordered at 105° F. 

3. Sterile bulb syringe. 

4. Sterile curved basin. 

5. Covered rubber sheet. 

6. Dressing tray or carriage. 

Procedure 

1. Wash your hands. 

2. Tell patient what you are going to do. 

3. Screen patient. 

4. Ask patient to turn on his side. 

5. Place covered rubber sheet under the part to 
be irrigated. 

6. Remove dressing as directed in "Changing a 
dressing." 

7. Place curved basin under wound. 

8. Fill bulb syringe with solution. 

9. Gently irrigate wound. 

10. Note character, odor, appearance of dis- 
charge. 

11. When all solution is used, apply a fresh 
dressing. 

12. Make patient comfortable, square away unit. 

13. Clean, wash, and boil equipment. 



SUGGESTED ADDITIONAL READING— UNIT III 



Eliason, Eldridge; Ferguson, L. Kraeer, and 
Sholtes, Lillian, Surgical Nursing. 9th ed. 
Philadelphia: J. B. Lippincott Co., 1950. pp. 
119-172. 

Lowsley, O. S., and Kerwin, T. J., Urology for 
Nurses. 2d ed. Philadelphia : J. B. Lippincott 
Co., 1948. 

Montag, Mildred, and Filson, Margaret, Nurs- 
ing Arts. Philadelphia: W. B. Saunders Co., 
1948. pp. 197-228, 411-565. 

Muller, Gulli L., and Dawes, Dorothy E., In- 
troduction to Medical Science. 2d ed. Philadel- 
phia : W. B. Saunders Co., 1948. 



Oxygen Therapy Handbook. New York: Linde 
Air Products Co., 1943. 

Wolf, Lulu K., Nursing Arts. New York: D. 
Appleton — Century Co., Inc., 1947. pp. 342- 
490. 

Young, Helen Lee, Eleanor, and Associates, Es- 
sentials of Nursing. 2nd ed. rev. New York: 
G. P. Putnam's Sons, 1948. pp. 187-424. 
Read current issues of periodicals for the latest 

information on new tests and treatments used for 

your patient. 

Periodicals available at most stations : Armed 
Forces Medical Technicians Bulletin and 
American Journal of Nursing. 



NURSING AND NURSING PROCEDURES 



257 



ADAPTATIONS OF NURSING CARE— UNIT IV 



Nursing care of the patient is a personalized 
service. The quality of the care rendered by the 
corpsman depends upon his ability to recognize 
the patient's needs and to call upon his previous 
knowledge in adapting his care to fit the needs 
of the patient. 

The preceding parts of this chapter have con- 
sidered the supportive measures, the diagnostic 
and therapeutic procedures which may be applied 
to the patient. 



This part of the chapter will discuss the adapta- 
tions and additional measures the patient may 
require. 

In adapting nursing care remember: 

1. A patient with a disease or condition is being 
cared for rather than a disease entity. 

2. The nursing care of the patient is adapted 
according to the way the patient is affected by 
this disease or condition. 



PLANNING PATIENT CARE 
Review, Chapter — Units II and III 






Planning the care of the individual patient may 
require the participation of all departments of the 
hospital. A special plan should be made for each 
patient. The nurse officer on the ward will guide 
you in planning such care. In most instances, the 
corpsman is assigned a group of patients, there- 
fore the suggestions for patient care plans are 
for group practice. 

1. List all the things you must do for, to, and 
with your patients. 

2. Plan around those procedures that must be 
done at a specified time. {Example: Lunch at 
1130.) Use the ward routine as a master plan. 

3. Plan to give the greatest portion of your 
time to your sickest patients. 

4. Plan to complete one thing before starting 
another. (Example: Do not start a bed bath for 
one patient at 0810 if you have another patient 
who must be in X-ray at 0815.) 

Check list relating to patient's comfort. — 
When making a list of the care needed by your 
patient, it is recommended that this check list be 
used in conjunction with the doctor's orders, ward 
report book, and the patient's chart. Many of the 
patient's discomforts may be corrected by the alert 
and observant corpsman without a doctor's order. 

Check the ward lights 

Are they glaring '. 

Are they bright enough ? 

Are they in the patient's eyes? 

Are they shaded ? 



Noise 

Is the ward noisy? 

Is there loud talking, laughing? 

Ventilation of ward 

Is the air fresh ? Stale? 
Are there odors? 

Temperature of ward 

Is it hot and stuffy ? 

What does the wall thermometer read? 

Is the patient in a draft ? 

Check the patient's bedding 

Does he have enough covers? 
Does he have too many covers \ 
. Is his bed linen clean 8 Wrinkled \ Wet '. 
Soiled? 
Is the bottom sheet tight and smooth ? 
Are the top covers light and loose? 

Appliances 

Does the patient have a cast? 

Is there pressure anywhere? 

Are there rough edges of the cast? 

Is the cast dry ? 

Are there cracks in the cast '. 
Is the pal ient in tract ion '. 

Are the weights hanging free? 

Is he up in bed \ 

Is the rope in the pulley groove? 

Is the traction pulling in the desired way? 

Is the frame causing pressure? 

Is the frame well padded I 

Is the foot or hand supported '. 



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HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Skin 

Is it clean ? 

Are there any scars? Sores? Rashes? Bnrns? 
Scratches? Bruises? Lumps? 

Are there any signs of pressure? Redness? 
Mottling ? Breakdown ? 

Position 

Is he comfortable? 
Does he move about in bed ? 
Has his position been changed in the past hour? 
Are the rubber rings, pillows, etc., in the right 
places? 

Intake 

Is he thirsty ? 

Is he drinking enough water ? Fruit juices? 

Is his drinking water fresh ? Can he reach it? 

Does he have a drinking tube ? 

Is he eating all his food? 

Is the tray attractive? 

Are the dishes and silver clean ? 

Is he in the best position to eat ? 

Does he need help ? 

Can he reach his food ? 

Output 

Is he voiding enough ? 

Does he have any difficulty or discomfort when 
he voids ? 

Does he perspire profusely ? 

When did he have his last bowel movement? 
Any difficulty? 

Pain 

Does he have pain? Where is it? 
How lonff has he had it ? 



How severe is it ? 

Is he nauseated with it? 

Does he have a backache? Headache? 

Mental State 

Does he appear worried ? Afraid ? Homesick ? 
Bored? Happy? Excited? Depressed? 

Sample plan for bathing four patients. — Four 
patients — two are bed patients requiring bed 
baths — two are bed patients able to help them-, 
selves. 

1. Visit all four patients. Find out how they 
feel and what new complaints or problems they 
have to offer. 

2. List all things you must do for, to, and with 
patients. 

Meals. 

Baths. 

Trips to other departments. 

Medications and treatments. 

3. Start bed bath for first bed patient. 

4. While he is finishing his bath (genitalia), 
bring equipment and water to the patient able to 
help himself. Strip his bed and let him start 
his bath. 

5. Make the bed and square away the unit of the 
first patient. 

C. Complete bath of second patient. Make his 
bed and square-away his unit. 

7. Repeat steps 4 through 6 for the other two 
patients. 

Note. — This is a general plan, it does not list the many 
interruptions the corpsman will probably encounter. 



THE SERIOUSLY ILL OR DYING PATIENT 
Review, Unit II, "Providing for the Patient's Comfort" 



Serious and Critical Lists 

Purpose: To notify various departments and 
the patient's relatives of the condition of a patient. 

Indicated : When ordered by the doctor. 

Procedure 

1. Check station orders for the type of form 
used; the number of copies to be made, and the 
departments to receive a copy. 

2. Notify the chaplain. 



3. When a patient is removed from the critical 
or serious list by the doctor, the same procedure 
is followed. 

Care of the Seriously III or Dying Patient 
Purpose: To keep the patient mentally and 
physically comfortable. 

Procedure 

1. Place the patient in a light, cheerful, and well- 
ventilated room. 



NURSING AND NURSING PROCEDURES 



259 



2. Keep the room quiet, clean, and clear of excess 
gear and equipment. 

3. Speak to the patient in a calm, natural tone 
of voice. Continue to tell him everything you are 
going to do even though he may appear to be un- 
conscious. The sense of hearing is thought to be 
the last faculty the patient loses. 

4. Use the "Check List Relating to Comfort" 
in anticipating your patient's needs (pp. 257- 
258). 

5. Give him small amounts of fluid every 1 to 
2 hours if he is conscious. Do not attempt to give 
fluids by mouth to an unconscious patient. 

6. Give mouth care every 2 hours if possible. 

7. Wash and rub his back and change his posi- 
tion every 2 hours. 

8. Give a complete bath every day and more 
often if he needs it. 

9. Provide frequent rest periods for your pa- 
tient. Do not tire your patient by taking "good 
care" of him ! 

10. Wateh for the following signs of approach- 
ing death; notify ward nurse and doctor. 

Failing circulation 

Change in pulse — may become rapid, thready, 
irregular, and soft, or become very slow and 
soft. 

Change in respiration — may become shallow 
and rapid or slow, gasping and edematous. 

Change in temperature — body temperature 
may be very high or subnormal. Skin ma} 7 feel 
very cold and moist to touch. Feet may become 
cold first, followed by hands, nose, and ears. 

Change in color — lips and fingernails may be- 
come cyanotic; buttocks and thighs mottled. 
Loss of muscle tone 

May become incontinent of urine and/or feces. 

Jaw sags, has difficult}' in swallowing. 

Loss of reflexes 

Pupils fail to react to light. 
Does not respond. 

11. Sign of death — absence of pulse and respira- 
tion. Xote time. 

12. The patient is pronounced dead by the 
doctor. 

Care of the Dead 

Equipment: To equipment for bed bath, add: 
One roll of absorbent cotton. 



Two rolls 3-inch gauze bandage. 
Three manila shipping tags* 
Two sheets. 
Eight safety pins. 

Procedure 

1. Lower the backrest, straighten the body, leave 
one pillow under the head. 

2. Close the eyes and replace the dentures. 

3. Change dressings, remove drainage tubes, 
close draining wounds with adhesive. 

4. Bathe the body. 

5. Place a pad of cotton over pubic region and 
rectum, secure in place with a T-binder bandage 
or by a piece of clean old muslin applied in diaper 
fashion. 

6. Cross arms over chest, wrap cotton around 
wrists, and tie together loosely with bandage. 

7. Wrap cotton around ankles and tie together 
loosely with bandage. 

8. Make out three manila tags listing name, rate. 
serial number, diagnosis, ward, date and time of 
death. 

Tie one tag to right great toe. 
Tie one tag to right wrist. 

9. Place a clean sheet diagonally under body. 
Fold upper corner of sheet over the head, lower 
corner over the feet, and both sides across the body. 
The body must be completely covered. Secure 
sheet with safety pins and/or bandage. Secure 
third manila tag on the outside of the sheet. 

10. Place the body on a stretcher and cover it 
with another sheet. Notify the morgue watch. 
The body should be transferred to the morgue 
without disturbing the other patients. 

Care of valuables 

1. Inventory and itemize all patient's gear in the 
room. 

a. Officer patient — must be done by two 
officers. 

b. Enlisted patient — must be done by officer 
and one enlisted person. 

2. Check station orders for additional instruc- 
tions. 

Care of the room or unit 

See "Cleaning of bedside unit." 

Note. — For patients who have died of communicable 
( l is( , : ,se — write "COMMUNICABLE DISEASE" in large 
red letters on manila tag. 



260 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



CARE OF THE PATIENT ON THE MEDICAL SERVICE 

Review — Chapter IV, Unit II, "Basic Nursing Care" 

Unit III, "Diagnostic and Therapeutic Procedures" 

Chapter V, "Diet in Disease" 

Chapter VI, "The Nature of Communicable Diseases" 

"The Body's Defense Against Disease" 

Chapter VII, Review section applicable to the particular patient 



Patients on the medical service are those whose 
conditions are treated by medication and/or treat- 
ments other than surgical intervention. 

The adaptation of nursing care to fit the needs 
of the patient on the medical service will be gov- 
erned by the patient's condition and the treat- 
ment prescribed by the doctor. The patient's 
treatment may consist of either complete bed rest, 
a special diet, a specific medication or treatment, 
or combination of these methods. 

In the care of the patient on the medical service, 
the corpsman should know : 

1. How to give basic nursing care with particu- 
lar emphasis on : 

Keeping the patient clean and comfortable. 
Protecting the patient and others from infec- 
tion. 

2. How to assist with diagnostic and therapeu- 
tic tests and examinations. 

3. How much and why the patient's activities 
are limited. 

4. Why a specific diet is prescribed. What 
foods are to be included or excluded. 

5. Why a particular medication or treatment 
has been ordered. What desired effects are to be 
expected ; what untoward effects he should be alert 
to observe. 

THE PATIENT WITH DIABETES 

Diabetes is a metabolic disorder probably due to 
a deficiency of insulin production by the islet cells 
of the pancreas. The treatment of the diabetic 
patient consists of the control of the condition by 
diet therapy and insulin administration. 

The corpsman's duties in the care of the diabetic 
patient : 



1. Basic nursing care with particular emphasis 
on personal cleanliness and preventing the spread 
of infection. 

2. Attention to diet. See diabetic diets, p. 325. 

3. Laboratory test. See diagnostic tests — uri- 
nalysis and blood tests, pp. 197-198 ; 200. 

4. Administration of insulin. See hypodermic 
injections, pp. 208-211. 

5. Close observation of the patient to prevent 
insulin shock or diabetic coma. 

Insulin shock — clue to too little food or over- 
dose of insulin : 

Symptoms 

Weakness, pallor, profuse perspiration. 
Hunger, dizziness, apprehension. 
Xervousness and tremor. 
Convulsions and coma, if untreated. 

Treatment 

Give sugar in some form such as orange'juice, 
sugar cubes, candy. 

Apply blankets. 

Notify doctor. 

Prepare equipment for an intravenous injec- 
tion of 50 percent glucose by the doctor if the 
patient is unconscious. 

Impending diabetic coma — due to too much 
food or too little insulin : 

Symptoms 

Loss of appetite, headache. 

Listlessness and drowsiness. 

Nausea and vomiting. 

Sugar, acetone and diacetic acid in urine. 

"Fruity" odor to breath. 

Treatment 

Notify doctor at once. 
Apply blankets. 



NURSING AND NURSING PROCEDURES 



261 



Regular insulin as ordered. 
Prepare equipment for an intravenous injec- 
tion of regular insulin by doctor if patient is 

unconscious. 

6. Teaching the patient. The patient with dia- 
betes will have to learn to live with his condition. 
His life can be a normal one with adjustments on 
his part in the matter of personal hygiene, diet, 
exercise, rest, and insulin administration. The 
corpsman can help his patient accept these limita- 
tions by : 

Encouraging the patient to stay on the diet pre- 
scribed by the doctor. 

Stressing the importance of personal hygiene 
with special emphasis on the care of the skin, teeth, 
and feet. 

Teaching the patient how to administer insulin 
to himself. 

Teaching the patient how to test his urine for 
sugar. 

Teaching the patient how to recognize the early 
symptoms of insulin shock and diabetic coma and 
what treatment to institute. 

THE PATIENT WITH A CARDIAC 
CONDITION 

The following are items of care needed by pa- 
tients with cardiac conditions. The treatment of 
the patient with a specific cardiac condition will be 
ordered by the doctor. 

The treatment of the patient usually consists of 
complete bed rest, supportive care, and administra- 
tion of medication. 

The corpsman's duties in the care of the patient 
are: 

1. Complete bed rest for patient. 
Assist patient with his oral hygiene, p. 18-1. 
Bathe the patient, pp. 186-187. 
Feed the patient, p. 191. 

Keep patient comfortable. See positions and 
devices for comfort, pp. 180-182. 
Assist with bedpan and urinal, p. 188. 
Allay fears and anxieties by prompt and 
cheerful service. The patient must be saved 
from even thinking for himself. 
3. Attention to diet. See "Cardiac diets," p. 

326. 
3. Regulation of fluids as prescribed. See "In- 
take and output," p. 188. 

211866°— 53 18 



4. Administration of- medicines, pp. 204-206. 
Precautions in administering digitalis. 

(1) Keep an accurate record of total dosage. 

(2) Take the patient's pulse before giving 
drugs, report pulse rate below 60 a minute and 
do not give drug unless specifically instructed. 

(3) Watch for symptoms of nausea and 
vomiting. 

Other drugs such as opiates, sedatives, and 
diuretics may be prescribed. Follow direc- 
tions accurately, carefully observe and record 
effects. 

5. Close observation of the patient. 

Edema — may appear in buttocks, legs, and 

ankles. 

Dyspnea — support the patient in the position 

he finds most favorable. 

Pulse— note the rate, force, rhythm and vol- 
ume when taking a pulse. Count for full minute. 

Cyanosis — may appear about the lips, finger- 
nails or buttocks. Oxygen may be ordered. See 
Administration of Oxygen, pp. 213-219. 

Pressure sores. See Care of Bed Sores, pp. 
189-190. 

6. Teaching the patient. 

The patient will have to learn to live within the 
limitations set by his condition. The corpsman 
can help his patient by : 

Encouraging the patient to accept these limita- 
tions. 

Showing him the importance of rest and modera- 
tion in all activities. 

Teaching him the importance of avoiding over- 
exciting stories, movies, and company. 
Teaching him the need of carrying and knowing 
how to use the medications ordered by the 
doctor. 

THE PATIENT WITH A COMMUNICABLE 
DISEASE 

There may be patients in a sick bay or hospital 
ward who are carriers of disease or whose com- 
municable diseases are hidden by other conditions. 

Most of the communicable diseases start with 
symptoms of a common cold or a gastrointestinal 
upset. When any patient presents these symp- 
toms, use precautionary measures until a diagnosis 
is established. 

The care of the patient with a communicable 
disease is essentially the same as for any other 



>o2 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



patient with the addition of medical aseptic 
techniques. 

The extent of medical aseptic technique required 
for a patient with a communicable disease will 
depend upon the modes of transmission, the source 
of infection and the period of communicability of 
the disease. 

Modes of transmission 

1. Through direct contact, by actually touching 
an infected person or natural source of infection, 
including transmission through air by droplets 
for short distance. 

2. Through indirect contact: 

a. By means of contaminated surfaces, arti- 
cles, or vehicles of infection. 

b. By air convection usually only for short 
time and distance. 

o. By anthropod or animal vectors. 

Sources of infection 

Reservoir — one or more species of animal or 
plant in which an infectious agent lives and mul- 
tiplies and depends principally for survival. 

Vector — an anthropod or other invertebrate that 
conveys the infectious agent from a person or ani- 
mal to another person or animal. Insects, spiders, 
mosquitoes, lice, ticks may be vectors. 

Vehicle — matter in or upon which infectious 
agents are present or survive until there is phy- 
sical contact with persons. 

Medical Aseptic Technique M 

Purpose: To confine the disease to the patient 
and to protect the worker and other patients from 
the infection. To protect the patient from new 
infection or reinfection. 

Isolation : 

For a unit in a noncommunicable disease 
ward: 

Select a part of the sick bay or ward that can 
be set up as an independent unit. A single room 
with running water is most desirable. Establish 
a zone around this area as contaminated. Be sure 
all personnel and other patients know and under- 
stand the limit of this zone. 



23 Adapted from: (a) Safer Ways In Nursing, New York: Na- 
tional Tuberculosis Association and National League of Nursing 
Education, 1948. (b) M10-2. Basic Principles of Aseptic Tech- 
nique, Washington : Veterans' Administration. 1946. (c) Ques- 
tionnaires. Communicable Disease Techniques: Naval Hospitals, 
1950. 



Equipment for unit 
For patient's use 

Thermometer and holder. 
Paper bag and wipes. 
Bath basin. 

Curved basin, glass, toothbrush and dentifrice. 
Bedpan and urinal. 
Razor, shaving cream, mirror. 
Wastebasket lined with large bag. or two thick- 
nesses of newspaper. 

For worker's use 

At entrance to unit (inside unit). 
Extra bedside stand with set up for masks if 
they are to be used. 

Set up for handwashing if sink is not available. 

Standard for gown. 

Hamper. 

For a unit in a communicable disease ward 

1. Establish zones within the ward as contami- 
nated, sometimes contaminated, and clean areas. 

Clean areas — doctor's office, nurses' station, be- 
tween cubicles, supply lockers, telephones. 

Sometimes contaminated zones — examining 
room, dish-sterilization room, utility room. 
These areas must be washed with soap and 
water and aired before being considered not 
contaminated. 

Contaminated zones — the immediate sur- 
roundings of the patient, the cubicle, the pa- 
tient's solarium, the lavatory and showers con- 
nected with the cubicle. All floors, inside of 
sinks and hoppers are considered contaminated. 
Be sure all personnel and patients know the 
limits of these zones. 

It may be helpful to designate and name the 
zones as : 

Red zone. — Contaminated zone. Every- 
thing within this zone must be sterilized or 
disinfected. 

Blue zone. — Sometimes contaminated. 
Everything used for the patient must be steri- 
lized or disinfected. 

White zone. — Clean zone — nothing is 
brought into this zone from the red without 
being disinfected or sterilized. Gowns and 
masks are not worn in the white zone except 
when cleaning. 

2. Group patients in cubicles according to their 
diagnoses : 



NURSING AND NURSING PROCEDURES 



263 



Patients with respiratory diseases together. 

Patients with gastrointestinal diseases to- 
gether. 

Patients with diseases carried by vectors to- 
gether. 

Patients with highly communicable diseases 
should be placed in separate rooms. 
3. Each cubicle should be considered as a sepa- 
rate unit. Each unit should have facilities for 
handwashing and gown technique at the entrance. 

Cleaning 

Keep down dust. Use sweeping compound or 
swab and buff decks; damp-dust furniture; wear 
gown and mask when cleaning and damp-dusting; 
follow daily and weekly cleaning schedules, i See 
"Ward Management.") 

Ventilation 

Fresh air is particularly important in a com- 
municable disease ward. There should be cross 
ventilation present all the time and the ward 
should be aired at least twice a day. 

Handwashing Technique M 
Methods 

Using sink with running water. — Hands and 
forearms are well lathered with soap, rubbed vig- 



-' The supply catalog lists soap and detergents with 3 percent 
hexacblorophene in cake and liquid form. 



1 Wash hands. 

2. With lorceps, 
remove mask 
from container. 





1. Open mask by pull- 
ing strings. 

2. Place mask over nose 
and throat; tie at back 
of head and neck. 



orously particularly around fingers ami nails and 

rinsed with hands held down to allow water to 
drain off finger tips. Hands and arm- arc dried 
with paper towels. 

Using basin. — To be used only when a sink is 
not within reasonable distance of unit. 

Suggested set-up: Bedside locker; bath basin : 
pitcher: pail with step-on cover: paper towel-; 
soap in soap dish; wastebasket. 

Method 

1. Pour water into basin from pitcher before 
entering unit. 

2. Wash and dry hands as described above. 

.'5. Holding basin on the outside, discard water 
into pail. 

4. Using a second paper towel, wipe inside of 
basin. 

5. Wash hands under running water as soon as 
possible. 

When hands are washed 

1. Before and after removing gown. 

•1. Before and after medications or treatment-. 

3. Before and after passing nourishments, 
water, or trays. 

4. Before going to meals or leaving ward. 

5. Before and after each task. 



1. Touching only strings, 
drop mask into con- 
tainer for soiled masks 

2. Wash hands. 




1 . Wash hands. 

2. Untie mask, holding 
string ends in hands 




~<&L 




^UT Es 









«'« 



1. Using paper towel, open 

faucet 
?. Wei honds. work up rich 

lather 



7 iw -♦ 

1 Wash hands and arms, rub- 
bing well around fingen and 
nails. 




&$ J 



1. Clean noils with nail stick or 
one nail with another. 

2. Rinse, re-lather. 




1 Rinse, allow water to dram 

off hnger tips 

2. Dry hands thoroughly with 
paper towal 



Figure 312. — Mask and Hand Washing Technique. 



264 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Mask Technique 

Method 

1. Masks are -washed, rolled, placed in a metal 
container and autoclaved. 

2. A mask is used once and then placed in used 
mask receptacle. 

3. A mask is worn until it becomes moist or for 
20 to 45 minutes. 

4. Once a mask is moist, it is contaminated. 
Do not put the mask in your pocket, leave it on 
a desk, or leave it dangling around your neck ! 
Get rid of it ! 

Gown Technique 
Methods 

1. Discard gown method is recommended : 

A clean gown is used each time it is necessary 
to enter the unit. 

Gown is removed, folded clean side out, and 
placed in hamper. 

Used gowns may be autoclaved or sent to 
laundry. 

Supply of clean gowns may be stored in bed- 
side table at entrance to unit. 

2. Single gown method : 

A gown is hung at entrance to unit. It is used 
by all personnel caring for the patient. 

When gown is removed, it is folded length- 
wise, contaminated side out, and hung on 
standard. 

3. Group gown method : This may be used 
where all patients on a ward have the same disease. 

A gown room is provided. This room should 
be near the entrance of the ward. Each mem- 
ber of the ward staff is assigned a hook on the 
gown rack. 

Equipment of gown room. 

A rack with sufficient hooks for each mem- 
ber of the staff. The hooks are labeled with 
each member's name. 

Shelves for clean supplies (gowns, masks, 
paper towels, soap ) . 

Cabinets for workers' clothes. 

Scrub sink with knee level's and foot oper- 
ated soap dispenser. 

Set-up for masks at entrance to room. 
Method 

A clean gown is used daily. 



When not in use, the gown is hung clean 
side out on the worker's personal hook. 

When gowns are worn 

1. When giving contact care; changing, sorting, 
or handling soiled linen. When sweeping and/or 
cleaning in the unit. 

2. Contact care is the care of the patient and 
his immediate surroundings. It includes bed 
baths, bed making, back rubs, treatments and 
taking temperatures. Serving trays, nourish- 
ments and medications ordinarily do not require a 
gown unless the patient needs assistance. 

3. All non-nursing personnel (i. e., doctors, phys- 
ical and occupational therapists, librarians, etc.) 
should wear gowns when in contact with the pa- 
tient. Use discard gown method. 

4. Visitors who spend long hours at the bedside 
of a seriously or critically ill patient should wear 
gowns. Use discard gown method. 

Glove Technique 
Method 

1. Wash hands. 

2. Gloves should be initially sterile. 

3. Put on gloves before entering unit. 

4. After use, wash gloves under running water. 

5. Boil for 5 minutes before returning to cir- 
culation. 

When gloves are worn. — When doing contact 
care for patients with syphilitic rashes, smallpox, 
and when handling dressings of patients with 
tetanus or gas gangrene. 

Goggles 

Method. — Wash goggles with soap and water 
between each use. 

When goggles are worn. — When doing irriga- 
tions of infected eyes or whenever there is a pos- 
sibility of the worker being exposed to a spray 
carrying infectious material. 

Handling Linen 
Method 

1. General : 

All soiled linen should be handled as little as 
possible. 

Avoid flicking linen about. 

Place linen in hamper or laundry bag directly 
from the patient's bed. 



NURSING AND NURSING PROCEDURES 



265 




1. Remove jumper; wash hands; put on 
mask. 

2. With palms together, slip hands inside 
gown; remove from hook. 




1 . Lap edges of gown together at back. 
Hold flap in place. 

2. Grasp belt end with free hand, bring 
to back. 




1. Touching only inside of gown, work 
arms and hands through sleeves. 

2. Place finger inside neckband, draw 
gown into place. 




1. Bring other belt end to back. 

2. Tie belt at back tightly enough to 
keep flap **■ olace. 

Removing Gown 





1. Tie gown at neckband in back. 

2. Grasp back edges of gown, bring to 
center back. 




1. Shrug shoulders once or twice to give 
sufficient working room. 

2. Push up sleeves of gown to conven- 
ient working level. 




Untie bell, push sleeves to 2 inches 
above contaminated area. 
Wash hands and arms without touch- 
ing cuffs of gown. 

Place 2 fingers under cuff, pull sleeve 
down over hand without touching 
outside of gown. 



1. With hand inside sleeve, draw other 
sleeve down over hand. 

2. Slip out of gown by working hands 
up to shoulder seams of gown. 



1. Keeping hands inside, lift gown off 
shoulders. 

2. Fold gown by bringing palms together 
at shoulder seoms of gown. 



HAW**-** 

1. Withdraw one hand, grosp gown just 
below neckband at center front. 

2. Withdraw other hand, bring bock 
edges of gown together just below 
neckband 

3. Hang gown on hook, contaminated 
side out. 



Figure 313. — Donning And Removing Gown — Medical Aseptic Technique. 



266 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



2. Isolated unit on a noncommunicable disease 
ward: 

Place laundry bag over the back of a chair 
inside the unit. 

Place contaminated linen in laundry bag as 
you remove it from the bed. 
Close laundry bag. 

Place bag inside clean bag held by clean corps- 
man at the entrance to the unit. 

Clean corpsman turns down an 8-inch cuff 
on clean bag. 

Clean corpsman holds the clean bag under 
the cuff. 

After the contaminated linen is placed in the 
bag, the clean corpsman closes the bag by 
turning up the cuff from the outside. 

Clean corpsman ties a shipping tag labeled 
"contaminated" on outside of bag. 
Send bag to laundry. 

3. On a communicable disease ward : 
Provide a hamper for each cubicle. 
Place linen in hamper for each cubicle. 
Close hamper bags; label "contaminated." 
Send bags to laundry at specified time. 
When counting and sorting linen before laun- 
dering is required : 




Figure 314. — Handling Contaminated Linen. 



Wear gown and mask. 

Spread clean sheet on deck. 

Remove and sort each piece of linen. Do 
not flick or toss linen about. 

Place clean sheet in linen carrier; place 
sorted linen inside sheet. Label carrier "con- 
taminated." 

Take or send carrier to laundry at specified 
times. 
When necessary. — For all patients on a com- 
municable disease ward. 

Handling Excreta (Feces, Urine, Vomitus) 
Requiring Additional Disinfection 
Method. — Use one of these disinfectants : Cresol 
4 percent ; benzalkonium chloride 1 percent. 

1. Prepare a section of the utility room by plac- 
ing several thicknesses of newspaper on deck. 

2. Use bedpan as a container. 

3. With tongue blades, break up solids to permit 
penetration by disinfectant. 

4. Add equal amount of disinfectant to excreta; 
cover and allow to stand for 1 hour. 

5. Write on a piece of paper the time the dis- 
infectant was added. 

6. After an hour, place bedpan in automatic 
flusher; flush and steam pan for 1 minute. 

When necessary. — For patients with amoebic 
and bacillary dysentery, cholera, typhoid fever, 
and poliomyelitis — when a municipal sewerage 
system is not available. 

Handling Discharges From Nose and Throat 
Method 

1. Isolated unit in a noncommunicable dis- 
ease ward: 

Pin paper bag to patient's bed. 
Supply patient with paper tissues. Provide 
sputum cup if patient is expectorating large 
amounts of sputum. 
Instruct patient : 

To cover his mouth and nose with tissues 
held in a cup-like fashion whenever he 
coughs, sneezes, talks to people. 

To place used tissues in the paper bag on 
his bed. 

To ask for new sputum cup when one is 
half-full. 



NURSING AND NURSING PROCEDURES 



267 



To place several tissues in top of sputum 
cup, place cup in paper bag, unpin bag, 
and close top of bag. 
Hold clean paper bag; ask patient to drop his 
bag into clean one. Close top tightly: place in 
burnable trash can or directly into incinerator. 
Wash your hands ! 

Provide patient with new bag, sputum cup, 
tissues if needed. 

2. For group of patients on communicable dis- 
ease ward : 

Set up utility cart : 

Top shelf — large waxed paper bags for 
patients' bags. String or bandage to tie wax 
bags. 

Bottom shelf — clean paper bags for beds, 
sputum cups, tissues. 
Collection. 25 

Instruct patients as above. 
Keep one hand clean for distributing 
clean supplies, one hand contaminated for 
collecting used supplies. 

Place used bags into large waxed bags — 
4 patients' bags to 1 waxed bag. 
When all are collected, tie waxed bags se- 
curely at top. 

Place all bags in burnable trash can for im- 
mediate incineration. 

Wash down utility cart with soap and 
water, rubbing vigorously for 2 minutes. 

When necessary 

When caring for patients whose diseases are 
spread by nose and throat discharges. 

Handling Food Trays 

Isolation tray in a noncommunicable disease 
ward 

1. Make two areas for tray in the utility room 
by spreading several thicknesses of newspaper -to 
full sheet size. 

2. Bring tray from patient's room and place it 
on one area. 

3. Scrape solids from dishes with knife or paper 
tray cover onto other area. 

4. Open bedpan sterilizer with foot pedal; pour 
fluids down sterilizer. 



20 Where patients are not able to assist, distribute clean supplies 
first. Carry out procedure for patients' bags : both your hands 
are contaminated. 



5. Wrap solids in one thickness of newspaper. 

6. With paper towel, push flush valve of bedpan 
sterilizer and open faucet in sink. 

7. Wash your hands thoroughly! 

8. Push down steam valve of bedpan sterilizer. 
Wrap solids in newspaper, touching only the out- 
side of the paper. Place in burnable trash can. 

9. Take tray on newspaper to dish carrier for 
main galley. 

10. Wash your hands ! 

On communicable disease wards 

1. Set up utility cart with pails for solids and 
liquids. 

2. Collect, scrape, and stack each tray. 

3. Bring cart to door of dish-sterilizing room. 

4. Wash dishes in hot soapy water. 

5. Place dishes, etc., on sides in slotted racks of 
sterilizer. 

6. Follow directions on sterilizer, watch tem- 
perature gage (180° F.), and time accurately! 

7. Allow dishes to air dry. 

8. Wash utility cart and shelves on contami- 
nated side of sterilizer vigorously with soap and 
water for 2 minutes. 

When necessary. — For patients with diseases 
spread by discharges from the nose and throat and 
gastrointestinal tract. 

Thermometer Technique 
Method 

1. Isolated unit on a noncommunicable dis- 
ease ward : 

Keep the thermometer at the patient's bed- 
side in a large test tube filled with 70 percent 
alcohol. Protect the thermometer tip by plac- 
ing a small amount of cotton in the bottom of 
the test tube. 

Strap the test tube to the foot of the bed with 
adhesive. 
Taking the TPR. 

Take a paper cup containing a cotton square 
moistened with water into the unit. 

Remove the thermometer from test tube; 
wipe down willi cotton. Read and shake 
down thermometer. 

Place thermometer in patient's mouth. 
Take his pulse and respiration. 
A t'i nee minutes, remove the thermom- 
eter from patient's mouth, wipe down in 



268 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



rotary motion with cotton, place cotton in 
paper cup. Read thermometer and place it 
in test tube. 

Discard paper cup in patient's waste basket. 

Wash your hands ! 

Record TPR in book at once. 
Care of the thermometer : 

Keep tube filled with alcohol 70 percent at 
all times. 

Twice weekly — remove tube from bed, take 
to utility room. Wash thermometer and fill 
tube with alcohol. Restrap tube with ther- 
mometer to foot of patient's bed. 
2. On a communicable disease ward 
In utility room : 
Thermometer tray containing 

Covered catheter tray filled with 70 percent 
alcohol and containing enough thermometers 
for ALL patients. 

Container for water. 

Container for soap solution. 

Container for cotton squares. 

Sputum cup for waste cotton. 

Preparation of equipment: Use a wheeled 
cart. 

Fill containers with water, soap solution, 
and cotton. Place on cart. 

Remove thermometers from alcohol, rinse 
under running water, and place in container 
of water. 

Procedure in ward: 

Pick up TPR book and pencil as you pass 
nurses' desk. Plan to take convalescent pa- 
tients' TPR first (negative patients on tuber- 
culosis service). 



Distribute 3 thermometers at a time (see 
TPR routine) . 

Place each thermometer in soap solution 
after it is read. 

When all temperatures have been taken, 
wheel cart to utility room. 

Wash each thermometer under running 
water, wipe down in rotary motion with cot- 
ton and place on paper towel. 

When all thermometers are washed, place 
them in the container of alcohol 70 percent. 

Wash water and soap solution containers. 
Place them upside down on the tray. 

Discard waste. 

Wash wheeled cart vigorously for 2 min- 
utes with soap and water. 

Wash your hands ! 

Daily 

Strip tray; place thermometers on paper 
towel. 

Filter alcohol. 

Boil containers for 10 minutes (alcohol, 
water, soap solution, and cotton containers). 

Reset tray, refill alcohol and cotton con- 
tainers and replace thermometers in alcohol. 

Terminal Disinfection 

1. Ordinary cleaning as described in cleaning 
a bedside unit is all that is necessary in most in- 
stances. Air all units for 24 hours after patient's 
discharge. 

2. Exception. — Patient discharged by death due 
to active communicable disease. 

Use isolation technique in disposal of linen 
and equipment. 

Wash walls with soap and water to height of 
6 feet. 

Air unit for 24 hours. 



NURSING AND NURSING PROCEDURES 



269 



Table V.-CHART OF SELECTED COMMUNICABLE DISEASES 



Disease and causative 
organism 


Source of infection, 
mode of transmission 


Incubation period, 
communicable period 


Common symptoms, 
possible complications 


Points in nursing care 


CHICKEN POX 
(Varicella) 

Caused by virus 


Source: Secretions of skin 
lesions, nose and throat 
infected persons. 

Spread: By direct contact 
with discharges from le- 
sions, nose, and throat of 
infected persons. Indi- 
rectly by articles freshly 
soiled with such dis- 
charges. 


Incubation: 2-3 weeks. 

Communicable: From one 
day before until r> days 
after the appearance of 

first crop of vesicles. 


Symplons: Mild chill and 
fever. Pain in buck and 
legs. Maoulopapular rash 

appears in 24 hours, fol- 
lowed by vesicular rash 
lasting 3-4 days. Rash 
first appears on trunk and 
covered portions of body. 
Different stages of rash 
may be on same region of 
body at same time. 
Complications: Secondary 
skin Infection, pneumonia, 
conjunctivitis. 


Isolate in separate room. Com- 
plete bed rest until 24 hours after 
temperature returns to normal. 

Caution patient against scratch- 
ing lesions. Pat, rather than rub, 
skin dry when bathing patient. 
Use care in combing his hair. 
Avoid loosening scabs. Oint- 
ments, if ordered, may be ap- 
plied to skin for relief of itching. 
Force fluids. Diet OS desired. 
Disinfection: All articles in con- 
tact With discharges. Incinerate 
paper banderchiefs and dressings 
soiled with discharges. 


COMMON COLD 

Caused by one or more 
viruses 


Source: Secretions from nose 
and throat of infectious 
persons. 

Spread: By direct contact 
with infected person. By 
cough or sneeze of infected 
person. Indirectly byarti- 
cles freshly soiled with 
nose and throat discharges. 


Incubation: 42-72 honrs. 

Communicable: IXiring in- 
cubation and early stage 
of disease. 


Symptoms: Sudden onset; 

slight fever, chilly sensa- 
tions, coryza. general lassi- 
tude, vague aches and 
pains in back and limbs. 
Complications: Bronchitis, 
pneumonia, sinusitis, oti- 
tis media . 


Isolation as can be accomrdislM 1 
by bed rest during the acute 
stage. Caution patient against 
violent nose blowing. Apply cold 
cream or bland ointment to up- 
per lip and about nares. Force 
fluids. Diet as desired. 

Disinfections: All articles in con- 
tact with discharges. Incinerate 
paper handkerchiefs soiled with 
discharges. 


DIPHTHERIA 

Caused by Klebs Loeffler 
bacillus 


Source: Discharges from 
nose, throat, nasopharynx 
of infected person or car- 
rier. Also contaminated 
milk. 

Spread: By direct contact 
with discharges from in- 
fected person or carrier. 
iDdire-ctly by articles 
freshly soiled with nose 
and throat discharges. 
Also by contaminated 
milk. 


Incubation: 2-5 days. 

Communicable: Until bacil- 
li disappear from secre- 
tions and lesions, usually 
2-4 weeks. 


Symptoms: Slight sore 
throat, moderate lever; 
hoarseness; dry tight 
cough; malaise; increascl 
pulse rate out of propor- 
tion to temperature; gray- 
ish white membraneous 
patch on mucous mem- 
brane of throat and upper 
respiratory passages; rest- 
lessness; dyspnea; cyano- 
sis. 

Complications: Broncho- 
pneumonia, suiTocal ion . 
myocarditis, paralysis of 
muscles used in swallow- 
ing and breathing, otitis 
media. 


Isolation in separate room until 2 
cultures from nose and 2 from 
throat are negative. Compete 
bed rest for 2-3 weeks or until all 
danger is past. Watch skin for 
petechias (tiny hemorrhages 
under the skin i watch for signs of 
choking. Have suction at hand, 
(live frequent oral hygiene. 
Hot throat irrigations may give 
comfort. Force fluids. Diet of 
semi-solids or as tolerated. 

Disinfection: All articles in contact 
with patient. 


INFLUENZA 

Caused by influenza virus 


Source: Probably discharges 
from mouth and nose of 
infected person or carrier. 

Spread: By direct contact 
with discharges and drop- 
let infection from infected 
person or carrier. Air 
borne? Indirectly by ar- 
ticles freshly soiled by dis- 
charges. 


Incubation: 24-72 hours. 
Communicable: Possibly 

from incubation until after 

fever subsides. 


Symptoms: Chills, fever, 
malaise, generalized aches 
and pains, intense head- 
ache, cough, sputum scant 
and watery at first, in- 
creases in amount and be- 
comes mucopurlcnt; 
mental depression, pros- 
tration out of proportion 
to symptoms. 

Com]>Hcations: Bronchitis, 
acute sinusitis, otitis 
media, pneumonia. 


Isolation in separate room or ward. 
Complete bed rest until 24 hours 
after temperature returns to nor- 
mal. Tcpiil sponges to refresh 
patient. Ice cap to relieve head- 
ache. Warm gargles may relieve 
throat irritation. Steam inhala- 
tions may relieve cough. .Main- 
tain cheerful attitude toward 
patient: keep room light and 
pleasant. Force fluids, diet as 
desired. 

Disinfection: All articles in contact 
with nose and throat discharges. 
Incinerate paper handkerchiefs. 


MEASLES (Rubeola) 

Caused by a virus 


Source: Secretions from nose, 
throat, eyes. 

Spread: By direct contact 
with infected person; by 
droplet. Indirectly by 
articles freshly soiled with 
discharges from mouth, 
nose and eyes. 


Incubation: 10 days from ex- 
posure to onset of fever; 
13-15 days to appearance 
of rash. 

Communicable: From4days 
before until 5 days after 
appearance of rash. 


Symptoms: Coryza, sneez- 
ing, cough, nausea, vomit- 
ing, chilliness, fever, small 
grayish white spots at 
gumline (Koplik spots). 
Rash appears third or 
fourth day; starts about 
cars, face, trunk and ex- 
tremeties. Fever in- 
creases during eruption, 
subsides as rash fades. 

Complications: Bronchitis, 
pneumonia, otitis media. 


Isolate in light airy room during 
period of com m unieabi 1 i ty . 

Avoid direct or glaring light; 
protect patient from drafts. 
Complete bed rest until tempera- 
ture returns to normal. When 
bathing use very little soap, pa 
rather than rub skin dry. Itch 
tag skin may be relieved by a 
5 percent solution of sodium" bi- 
carbonate. Petrolatum may be 
applied about nans and lips. 

Oner mouth wash and gargles 
frequently. 
Disinfection: All articles in contact 

with discharges. Incinerate 
paper handkerchiefs and dress- 
ings soiled with discharge from 
nose, throat, eyes. 



1 Sources.— Teresa Lynch, Communicable Disease Nursing (St. Louis, C. V. Mosby Co, 2d Ed.) 1949. Helen Young, fed.) Uppincott's Quick Reference Book, 
For Nurses (Philadelphia, J. B. Lippincott, 6th ed.) 1950. The Control of Communicable Disease in Man 7th ed. (Washington, D. C, Federal Security 
Agency, TJSPHS) 1950. 



2/0 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Table V.-CHART OF SELECTED COMMUNICABLE DISEASES-Continued 



Disease and causative Source of infection, 
organism mode of transmission 


Incubation period, 
communicable period 


Common symptoms, 
possible complications 


Points in nursing care 


MENINGOCOCCUS 
MENINGITIS 

(Cerebrospinal Fever) 

Caused by cocci 


Source: Discharges from 
nose and throat of patient 
and carriers. 

Spread: By direct contact 
with patient or carriers. 
Indirectly by articles 
freshly soiled with infec- 
tious discharges. 


Incubation: 2-10 days. 

Communicable: Until nose 
and throat discharges are 
negative for meningococci. 


Symptoms: Sudden onset; 
fever, intense headache, 
nausea, vomiting, pete- 
chial skin rash; neck be- 
comes stiff; patient stupor- 
ous or lapses into coma. 
Patient may assume opos- 
thotones position (spine 
arched backward to an ex- 
treme degree). 

Complications: Pneumonia. 


Isolate in quiet, slightly darkened 
room. Change pafent's posi- 
tion frequently. Use small pil- 
lows and other devices for com- 
fort. Patient is very sensitive to 
noise, light and touch. Handle 
him gently. Give frequent back 
care to avoid pressure sores. Givp 
oral hygiene before and after feed- 
ing. Apply ointment about lips. 
Protect eyes from bright lights. 

Disinfection: All articles sr.iled by 
nose and throat discharges. 
Incinerate paper handkerchiefs. 


MUMPS 

(Infectious 
Parotitis) 

Caused by virus of mumps 


Source: Saliva of infected 
person. 

Spread: By droplet and di- 
rect contact with infected 
person. Indirectly by 
articles freshly soiled with 
saliva of such person. 


Incubation: 12-26 days. 

Communicable: From 2 
days before until swelling 
of glands have subsided. 


Symptoms: Chilliness, mal- 
aise, moderate fever, pain 
on swallowing and chew- 
ing. Swelling below and 
in front of ear. The sur- 
rounding tissues are ede- 
matous; the submaxillary 
glands often swollen and 
tender. Features are dis- 
torted. Movements of 
jaw are restricted and 
painful. May affect one 
or both sides. 

Complications: Orchitis, 
oophoritis, pancreatitis, 
mastitis. 


Isolation for period of communica- 
bility. Complete bed rest until 
after swelling has subsided . Heat 
or cold may be applied to affected 
(patient's preference). Special 
mouth care with frequent mouth 
washes or gargles. Force fluids 
and semi solids. Avoid acid fruit 
juices. A scrotal bridge may be 
ordered for male patient. 

Disinfection: All articles in contact 
with nose and mouth discharges. 
Incinerate paper handkerchiefs. 


PERTUSSIS 

(Whooping Cough) 

Caused by pertussis bacillus 


Source: Discharges from 
throat of infected persons. 

Spread: By direct contact 
with infected persons, by 
droplet infection. Indi- 
rectly by articles freshly 
soiled with such dis- 
charges. 


Incubation: 7-10 days. 
Communicable: From onset 

of first symptoms until 

"whoop" appears. 


Symptoms: Chilliness, ma- 
laise, moderate fever, 
coryza. dry hacking cough. 
Cough gradually becomes 
severe until characteristic 
whoop is noted. The 
paroxysmal stage is 
marked by coughing at 
intervals of varying fre- 
quency. Repeated par- 
oxsyms of coughing, loss 
of breath, whooping, and 
vomiting leave the pa- 
tient exhausted, perspir- 
ing and apparently dazed. 

Com plications: Broncho- 
pneumonia, hernia, hem- 
orrhage, prolapse of rec- 
tum, convulsions. 


Isolation in a separate, well-venti- 
lated room. Patient should be 
kept quiet. Tight abdominal 
binder may give some support 
during paroxysms. Serve bland 
nourishing foods, neither very 
hot nor very cold. If patient 
vomits soon after eating, feed 
again. 

Disinfection: All articles soiled with 
discharges from nose and throat. 
Incinerate paper handkerchiefs. 


PNEUMONIA 

A. Acute lobar. 

Caused by pneumococci 


Source: Probably discharges 
from nose and mouth of 
infected persons. 

Spread: By direct contact 
with infected person. In- 
directly by articles freshly 
soiled by such discharges. 


Incubation: Possibly 1-3 
days. 

Communicable. Unknown, 
thought to be until organ- 
isms no longer present in 
discharges. Possibly by 
minute suspended parti- 
cles containing infectious 
agent. 


Symptoms: Abrupt onset 
with chill. Rapid rise in 
temperature to 104°-106° 
F; Skin hot and dry; mal- 
aise and headache; Pain 
in chest; Patient lies on 
affected side. Flushed 
face, cyanoisis about lips. 
Herpes on lips. Increased 
respirations with respira- 
tory grunt. Cough with 
tenacious rusty sputum. 
Pulse full and bounding. 
Delirium may be present. 

Complications: Spread to 
another part of lung, pleur- 
isy with effusion, empy- 
ema, pericarditis, endo- 
carditis, meningitis. 


Isolate patient in a separate, warm 
well-ventilated room free from 
drafts. Encourage patient to rest 
and relax. Complete bed rest is 
basic treatment. Plan procedures 
so as to disturb patient as little as 
possible. Change position every 
3-4 hours. Daily bath, occasional 
back rub with lanolin or cocoa 
butter for elderly patients may 
prevent dry itching skin. Spe- 
cial mouth care every 3 hours. 
Apply ointment to lips to keep 
them soft. Force fluids. Diet as 
desired. See "Oxygen Therapy" 
for administration of oxygen. 

Disinfection: All articles soiled by 
nose and throat discharges. In- 
cinerate paper handkerchiefs. 


B. Primary atypical. 
Caused by virus 


Source: Discharges from the 
nose and throat. 

Spread: By direct contact 
with infected person. In- 
directly by articles freshly 
soiled by nose and throat 
discharges. Mild unrecog- 
nized infections may help 
spread of disease. 


Incubation: Not definite, 

may be 7-21 days. 
Communicable: Unknown 

length of time. 


Symptoms: Chilliness, fa- 
tigue, malaise, fever, range 
99°-104°F. Intense head- 
ache. Painful and ex- 
hausting cough with scant 
sputum. 

Complications: Pericarditis, 
pleurisy, empyema, en- 
cephalitis. 


Similar to points listed under "A", 
bed rest for several days after 
temperature returns to normal. 



NURSING AND NURSING PROCEDURES 



271 



Table V.— CHART OF SELECTED COMMUNICABLE DISEASES— Continued 



Disease and causative 

organism 



Source of infection, 
mode of transmission 



Incubation period, 
communicable period 



Common symptoms, 
possible complications 



Points in nursing care 



POLIOMYELITIS 

(Infantile Paralysis) 

Caused by virus of 
poliomyelitis 



Source: Discharges from 
nose, throat, Intestinal 
tract of acutely ill anil 'or 
convalescent patient, car- 
rier. 

Spread: Nbl definite. Close 
association with infected 
persons. Portal of entry 
may be nose and throat 01 
gastrointestinal tract. 



Incubation: Usually 7-14 
days. -May be 3-35 days. 

Communicable: Latter pari 
of incubation period and 
first week of illness (not 
definite). 



Symptoms: Three stages. 

First stage: Gastrointes- 
tinal upset, fever, head- 
ache, malaise. Second 
stage: Meningeal irrita- 
tion, severe headache, 
pain and slilfness in back 
of neck and limbs, muscle 
spasm. Third Stage: Se- 
vere involvement of nerv- 
ous system, paralysis. 
Patient may progress to 
all three stages, or disease 
may be limited to first 
and 'or second stage. Often 
paralysis is the first sign of 
the disease. 
Complications: Atelectasis 
and pneumonia in patient 
with respiratory paralysis. 
Renal calculi, atrophy of 
paralyzed muscles. 



SCARLET FEVER 

Caused by hemolytic 
streptococci 



Source: Discharges from 
nose and throat, abscesses. 
wounds of infected per- 
sons. Also carriers. 

Spread: Direct contact with 
patient or carrier. .May be 
airborne. Articles freshly 
soiled by discharges of in- 
fected person or carrier, by 
contaminated milk and 
milk products. 



Incubation: Usually 2-5 
days. 

Communicable: Until feu- 
days past clinical recov- 
ery, all abnormal dis- 
charges stopped, open sores 
or wounds have healed. 






Symptoms: Sudden onset, 
sore throat, vomiting, rap- 
id rise in temperature. 
Tongue heavily coated, in 
few days becomes bright 
red. swollen, "strawberry 
tongue." Forehead and 
neck flushed, region 
around mouth is usually 
pale. Pulse is rapid, appe- 
tite is poor , bowels consti- 
pated, urine scanty. Rest- 
lessness, headache, insom- 
nia, delirium, and convul- 
sions may occur during 
ing disease. 

Complications: Cervical ad- 
enitis, otitis media, ne- 
phritis, arthritis, rheu- 
matic fever, endocarditis. 



SMALLPOX (Variola) 

Caused by virus of smallpox 



Source: Lesions of mucous 
membranes and skin of 
infected person. Dried 
crusts from skin lesions re- 
main infectious for long 
periods. 

Spread: Direct contact with 
infected person. In- 
directly by articles soiled 
with discharges from 
lesions. 



Incubation: 8 Hi days. 
Communicable: From first 

symptoms to disappear- 
ance of all scabs and crusts. 



Symptoms: Sudden onset, 
headache, malaise, vomit- 
ing, sudden rise in tem- 
perature. Severe back- 
ache on third or fourth 
day, macular rash appears 
on face, forearms, hands, 
and spreads rapidly over 
entire body. Rash be- 
comes papular, changes to 
vesicles, then to pustules, 
crusts. Face is swollen, 
lesions appear in mouth 
and throat, characteristic 
musty odor is present. 
Patient is very toxic. 

Co mplications: S e condar y 
Infection, conjunctivitis, 
laryngit is. septicemia, 
nephritis. 



Isolation in separate ward or room 

Complete bed rest on a linn bed. 
Place fracture hoard under mat- 
tress, t'se a covered Foot t* 
separated from mattress by 
blocks to prevent pressure of 
bedding on toes and to provide 
firm base for soles of feet when 
patient is in prone position. See 

■■ Positions tor comfoi I " Wot ten 
or cotton blankets should be next 

to patient. Physical and menial 
rest are essential; avoid dl 
and glaring lights. Corpsman't 
hands should be warm when 
touching patient. In the acute 
e. support patient's body 
in the position be assu 
(first 21-18 hours). Later main- 
tain body In good alinement. 
Baths are frequently omitted 
during acute stage, when bath- 
ing, ust? gentle sponging move- 
ments ami dry by blotting rather 
than rubbing. fluids during 
acute stage, diet as desired later, 
(live hypertonic lluids when hot 
packs are ordered (usually) as 
soon as diagnosis is made. See 
"Lay on packs." Watch for nasal 
voice, hoarseness, difficulty in 
swallowing, twitching of facial 
muscles characteristic of bulbar 
type. Should respiratory paraly- 
sis develop, patient may be 
placed in a respirator. 
Disinfection: All articles soiled by 
nose and throat discharges. In- 
cinerate paper handkerchiefs. If 
municipal sewerage is not avail- 
able, disinfect feces before dis- 
posal. 



Isolation in separate room. Com- 
plete bed rest until 24 hours 
after temperature returns to nor- 
mal. Tepid sponges may be 
given to reduce temperature. Ad- 
dition of sodium bicarbonate to 
bath water may relieve itching. 
Olive oil or cocoa butter applied 
during desquamation period adds 
to patient's comfort. Never use 
alcohol during desquamation 
stage. Give mouth care q4h; 
throat irrigations or gargles may 
give relief during sore throat 
stage. Accurately measure intake 
and output. Fluids and semi- 
solids during acute stage. 

Disinfection: All articles soiled with 
discharges Irom nose, throat, 
sores, wounds. Incinerate paper 
handkerchiefs and dressings. 



Isolate in separate room. Wear 
close-fitting cap in addition to 
gown. Place cradle over painful 
portions of patient's body. Tepid 
sponges and sedatives may re- 
lieve restlessness, delirium. Ad- 
dition of sodium bicarbonate to 
bath water may relieve itching. 
Applications of ointments to 
hands and feet may soften skin 
to help lessen pain of rash break- 
ing through skin. Do not re- 
move crusts forcibly, allow them 
to drop oil. Mouthwash of 
penicillin is frequently given 
when lesions are on mucous mem- 
branes. Hot throat irrigations 
may be helpful. Apply cream 
about lips and nares. Protect 
eyes from direct light, apply 
ointment to lids, eye irrigations 
may be ordered. Force lluids 
and semisolids. Feed patient 

when hands are Involved in rash. 

Disinfection: All articles in contact 
w it'll patient or sailed by dis- 
charges. Use special care in 
handling linen. Incinerate paper 
handkerchiefs and dressings. 



272 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Table V.— CHART OF SELECTED COMMUNICABLE DISEASES-Continued 



Disease and causative 
organism 


Source of infection, 
mode of transmission 


Incubation period, 
communicable period 


Common symptoms, 
possible complications 


Points in nursing care 


TUBERCULOSIS 

(Pulmonary) 

Caused by tubercle bacilli. 


Source: Persons with "open 
tuberculosis (sputum, nose 
and throat discharges con- 
tain tubercle bacilli). 

Spread; Direct or indirect 
contact with infectious 
persons; by means of 
coughing, sneezing, drop- 
lets. Infections rarely 
occur from casual contact 
but usually from long and 
close exposure. 


Source: Variable. 

Communicable: As long as 
the tubercle bacilli are dis- 
charged by the patient. 


Symptoms: Fatigue with- 
out cause, loss of weight, 
cough of three or more 
weeks duration which does 
not respond to treatment. 
Loss of appetite and diges- 
tive disturbance. Night 
sweats. Afternoon tem- 
perature elevation. Tu- 
bercle bacilli' may be found 
in sputum and/or gastric 
washings. Lesion may be 
found on chest X-ray. 

Complications: Spread, 
pleurisy with or without 
effusion, hemorrhage, 
atelectasis, spontaneous 
pneumothorax. 


Isolation in separate room or ward. 
Tuberculosis is a long-term dis- 
ease, therefore morale is an im- 
portant factor. Rest in the most 
important part of treatment. En- 
courage strict observance of a. m. 
and p. m. rest periods. Teach 
patient ways to protect himself 
and othere from infection. Daily 
bathing if condition permits, 
watch closely for pressure sores 
on bony prominences. Demon- 
strate care of sputum, sputum 
cups. Foods high in vitamin 
B and C should be given, served 
attractively and at the proper 
temperature. 

Disinfection: All articles in contact 
with patient. Incinerate paper 
handkerohiefs and sputum caps. 


DYSENTERY 

A. Amebic (amebiasis) 
Caused by endomoeba 
histolytica 


Source: Feces of infected per- 
sons, especially carriers. 

Spread: Indirectly by foods, 
articles, water, flies. 


Incubation: £days to several 
months, commonly 3-4 
weeks. 

Communieable: During 
course of-infection and un- 
til feces are negative for 
ameba. 


Symptoms: Diarrhea and 
abdominal cramps. Fever, 
weight loss, general de- 
bility, diarrhea, often 
bloody or watery stools, 
foul odor to feces. May be 
alternate constipation and 
diarrhea. 

Complications: Liver ab- 
scess, hepatitis, lung ab- 
scess. 


Room with screened door and win- 
dows. Complete bed rest during 
acute stage. Teach patient to 
wash hands after defecation and 
before handling food. Measure in- 
take and output. Chart descrip- 
tion of each stool. During acute 
stage feed patient frequent 
small meals high in carbohy- 
drates, after acute stage diet 
should be high in protein. Avoid 
fruit juices, leafy vegetables, sal- 
ads. When emetine hydrochlo- 
ride is being administered, watch 
patient for symtoms of visual 
disturbance, increased pulse rate, 
fall in blood pressure, pallor or 
cyanosis. 

Disinfection: All articles in contact 
with discharges from alimentary 
tract. Disinfect feces before dis- 
posal if municipal sewerage is 
not available. 


B. Bacillary (shigellosis) 
Caused by various species 
of shigella 


Source: Feces of infected 
persons and carriers. 

Spread: Indirectly by foods, 
water, articles contam- 
inated by infected person 
or carrier; also contam- 
inated flies. 


Incubation: 1-7 days. 

Communicable: During dis- 
ease and until feces are 
negative for organisms. 


Symptoms: Mucus or bloody 
diarrhea, abdominal 
cramps, tenesmus, fever, 
prostration. In severe 
cases, marked dehydra- 
tjon, abdominal disten- 
tion, coma. 

Complications: Arthritis, 
pneumonia. 


Room with screened door and win- 
dows. Bed rest depends upon the 
severity of disease. In acute stage, 
prevent chilling, keep room 
warm and quiet. Because disease 
may be of long term duration and 
be debilitating, daily baths with 
special attention to bony prom- 
inences are Important. Devices 
for comfort should be employed 
where useful. Special mouth 
care q3h; force fluids during acute 
stage, avoid milk. Give frequent 
small meals, gradually return to 
normal diet. 

Disinfection: Same as for amebic. 


TYPHOID FEVER 

Caused by typhoid bacillus 


Source: Feces or urine of in- 
infected persons and car- 
riers. 

Spread: Direct contact with 
patient or carrier indirect- 
ly by contaminated water, 
food, milk, shellfish, flies. 


Incubation: 3 to 38 days, usu- 
ally 7-14 days 

Communicable: From first 
symptoms throughout 
convalescence or until ex- 
creta is repeatedly nega- 
tive for organism. 


Symptoms: Variable, lasts 
4-fi weeks. First week: con- 
stant severe headache, ir- 
regular pulse, cough, bron- 
chitis, constipation or di- 
arrhea. Epistaxis (nose 
bleed), fever higher each 
p. m. until it reaches 104°- 
105° F. Second week: 
Fever remains high, heav- 
ily coated tongue, sores, 
rose spots on abdomen, 
pulse slow in proportion 
to temperature, dullness, 
lethargy, low muttering 
delirium, eyes open and 
staring. Third week: Grad- 
ual decline in temperature, 
beginning of convalescence. 
Convalescence is long, 
may be 2 weeks to several 
months. 

Complications: Intestinal 
hemorrhage may occur 
in second or third week. 
Perforation of intestine 
may occur late in disease. 
Phlebitis, bronchitis, 
pneumonia, cholecystitis. 


Isolate in room with screened door 
and windows. Plan care to pro- 
vide maximum rest for patient. 
During period of high fever take 
rectal temperatures, give tepid 
sponges, ice cap to head, mouth 
care q3h. Watch bony promi- 
nences closely for pressure areas, 
avoid pressure on abdomen when 
bathing patient. Stay with pa- 
tient during delirium. Allow 
patient to chew gum if he is able. 
If constipation is present, ene- 
mas may be ordered, give very 
slowly. Cathartics are not given 
because of danger of perforating 
intestines. Diet — high caloric, 
high carbohydrate in frequent 
small meals. Force fluids. Pa- 
tient may be fed because of 
lethargy and poor appetite. 

Disinfection: All articles in contact 
with patient. Disinfect excreta 
before disposal when municipal 
sewerage is not available. In- 
cinerate all burnable materials. 



NURSING AND NURSING PROCEDURES 



273 



Table V.— CHART OF SELECTED COMMUNICABLE DISEASES— Continued 



Disease and causative 
organism 


Source of infection, 
mode of transmission 


Incubation period, 
communicable period 


Common symptoms, 
possible complications 


Points in nursing care 


MALARIA 

Caused by protozoan para- 
site (four types). 
Plasmodium vivax 
Plasmodium falciparum 
Plasmodium ovale 
Plasmodium malariae 


Source: The blood of in- 
fected person. 

Spread: By bite of infected 
anopheline mosquitoes. 


Incubation: Varies with 
species of infecting organ- 
ism and the number in- 
fected. 

Communicable: As long as 
sexual form of organism 

exists ill blood in sufficient 
quantities to infect anoph- 
eline mosquitoes. 


Symptoms: Shaking chills, 
periodic fever, headache, 
malaise, skin hot and 
flushed during chills and 

high fever. After chills, 

profuse diaphoresis, ex- 
treme thirst, delirium, 

spiking temperature, 
backache 
Complication*: Anemia, 

hemoglobinuria, frequent 
relapses. 


Room with screened dooi 
windows. If not available. 
netting over bed. Bed rest •lur- 
ing paroxysms of chills and fever, 
fold stage: apply blanker 
water bottles, urge hot drink*. 
As hot stage develops (inn 
ately after cold stage) gradually 
remove heat. Tepid sponges 
and ice cap to bead may help dur- 
ing this stage. Force cold Quids. 
Place small pillow under small 
of bock to relieve ache. If deliri- 
ous, apply sidebars to bed as 
safety measure. Sweating stage 
follows hot Btage, temperature 
drops rapidly, profuse diaphore- 
sis. Force fluids, change linen 
frequently, keep dry, avoid drafts 
to prevent chilling patient. 
Three stages may last 6-10 hours. 
Observe and record time, severity 
and duration of each stage. 


DENGUE 

Virus of dengue fever 


Source: Blood of infected 
persons one day before and 
up to 5 days after onset. 

Spread: By bite of mos- 
quito, infected by biting a 
patient during the above 
period. The mosquito be- 
comes infectious after an 
interval of 8-11 days. 


Incubation: 3-15 days. 
Communicable: From day 

before onset until the fifth 

day of disease. 


Symptoms: Sudden onset, 
high fever, intense head- 
ache, joint and muscle 
pains, irregular eruption. 
Intense pain in eyes may 
be a complaint. 

Complications: Rare, 
asthma, peripheral neuri- 
tis. 


Room with screened door and 
windows for 5 days. Bed rest 
during fever period. Ice cap to 
head. Cradle to keep top covers 
off painful joints. Calamine 
lotion to relieve itching. Protect 
eyes from direct or strong light. 
Cold compresses to eyes may be 
soothing, trge patient to keep 
eyes closed as much as possible. 

Disinfection: As for general hos- 
pital patient. 


PLAGUE 

Caused by plague bacillus 
Types: 
Pneumonic 
Bubonic 


Sotirce: Infected rodents and 
patients. 

Spread: Direct by droplet, 
nose and throat discharges 
in pneumonic form. Bu- 
bonic transmitted from ro- 
dent to man by bite of flea. 


Incubation: 3-6 days. 

Communicable: Pneumonic 
during active stage. Bu- 
bonic — not communicable 
from man to man. 


Symptoms: Pneumonic 
forms: Bronchopneumo- 
nia develops rapidly, spu- 
tum bloodstreaked and 
watery. This form is usu- 
ally fatal in short time. 

Bubonic forms: Sudden on- 
set; headache, vomiting, 
prostration. Delirium, 
conjunctiva injected, fa- 
cial expression of weariness 
characteristic. Tongue 
furred and swollen, sub- 
cutaneous hemmorrhages 
giving rise to term "Black 
Death." Lymph glands 
become swollen, painful, 
and may suppurate, espe- 
cially those of the neck, 
groin, and axilla. 

Complications : High 
mortality rate, secondary 
pneumonia, and pleurisy. 


Isolation in room with screened 
windows. 

In pneumonic type: Worker wears 
Close fitting hood, goggles, cover- 
alls, rubber gloves. Nursing rare 
that of pneumonia. Rulionic 
Type—nursing rare is that of ty- 
phoid [ever. The patient is very 
ill and needs constant care. 

THztnftciion In pneumonic type 
all sputum, tissues, contaminated 
with mouth and nose secretions 
must be burned. In bubonic 
type, burn all dressings and 
bandages. Both t\|>es: all con- 
taminated equipment must !><■ 
disinfected. Area of original in- 
fection should he treated to de- 
stroy rats ami fleas. 

Terminal disinfection: Clean walls. 
floors, etc. with 5 percent solu- 
tion compound cresol. Air room 
for 48 hours. 


TYPHUS FEVER 

Caused by riekettsia 
prowazeki 

A. Epidemic 

B. Endemic 


Source: 

A. Epidemic type, infected 
persons. 

B. Endemic type, infect- 
ed rats. 

Spread: 

A. Epidemic type. Bite 
of infected louse, or feces of 
infected louse inoculated in- 
to bite or wound. 

B. Endemic type, bite of 
fected flea. 


Incubation: 0-15 days. 

Communicable: Not from 
man to man. Patient is 
infective to lice during 
fever and possibly 2-3 days 
after temperature is nor- 
mal. 


Symptoms: High fever, 
chills, severe headache. 
severe back and general- 
ized body aches aii' 1 pains. 
Rash about fifth day cov- 
ering trunk but avoids 
hands, feet, face. Cough, 
bronchitis. Pulse slower 
than fever would indicate. 
May become stuporous, 
delirious. 

Complications: Bronchitis, 
bronchopneumonia, otitis 
media, mastoiditis. 


Place in room or ward after all lice 
and nits have been removed 
from his person. Patient and 
bedding should be dusted with 
DOT once a week during febrile 
period. Force fluids during pe- 
riod of high fever. Care is sim- 
ilar to that of typhoid fever. 

IHsinfti-tinn: As for a general hos- 
pital patient. Handle linen care- 
fully. 



274 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



THE CARE OF THE PATIENT ON THE SURGICAL SERVICE 

Review, Chapter III, "Shock," "Inflammation," "Hemorrhage," "Wounds," "Emergency Medi- 
cal Care" 



Patients on the surgical service are those who 
have had or are to have operations. Their care 
will be basic patient care plus surgical aseptic 
techniques and the therapeutic nursing procedures 
required by their local condition. 

Preoperative Care 

The success of an operation depends to a large 
extent upon the preoperative condition and prep- 
aration of the patient. 

The corpsman is responsible for the physical 
preparation of the patient according to the doc- 
tor's order. The mental preparation of the pa- 
tient, while not a written order, is just as im- 
portant to the patient and to the success of the 
operation. The corpsman should keep in mind 
that regardless of how the operation is recorded 
in the records (i. e., major or minor) it is always 
a serious major operation to the patient. 

The patient's fear of the operation itself ; of not 
knowing what to expect ; of being at the mercy of 
others without a chance of defending himself, or 
of not knowing what the outcome will be, have 
considerable bearing on his disposition toward the 
operation. The corpsman through his close as- 
sociation with the patient is able to lessen his fears 
by explaining and performing his tasks in a con- 
fident manner, by observing and reporting to the 
doctor when more technical and professional ad- 
vice is indicated. 

When a patient is scheduled for operation, the 
corpsman should routinely notify the chaplain of 
the patient's faith. The chaplain will be able to 
give the patient advice and guidance in family or 
religious matters. 

Usually the patient will be in the hospital sev- 
eral days or weeks prior to the operation. He 
will have a complete physical examination, nu- 
merous laboratory tests, medications, and treat- 
ments ordered to bring him to the best physical 
condition for operation. During this period he 
will have time to think and ponder over the pos- 
sible result of the operation. Confidence in all 
personnel, explanation and assurance by the doctor 
of his ultimate recovery, will help in having the 
patient in mental readiness for the operation. 



A signed permission must be obtained for all 
patients (other than service personnel) before the 
operation. 

Skin Preparation Procedure 

Definition : Skin preparation consists of cleans- 
ing and shaving an area sufficiently large to pro- 
vide ample field for operation. 

Purpose: To make operative field as clean as 
possible. 

Time and place: Evening before surgery — 
either in surgery or on ward. 

Equipment 

Safety razor with new blade. 

Green soap and warm water. 

Clean gauze sponges or flats. 

Curved basin. 

Rubber sheet with cover. 

Applicators. 

Spot light. 

Procedure 

Wash your hands ! ! Refer to chart for proper 
area to be prepared for operation (fig. 315-316). 

1. Explain the procedure to the patient. 

2. Screen patient to provide privacy. 

3. Place covered rubber sheet under area to be 
prepared. 

4. Place light at best angle to see hairs. 

5. Moisten gauze, lather small area at one time. 

6. Shave in direction of hair growth. Avoid 
scratching the skin with razor. 

7. Clean umbilicus with moistened applicators 
if an abdominal preparation. 

8. Inspect lumbar area, shave area if hair is 
visible for patient having spinal anesthesia. 

9. Have patient take a shower or tub bath after 
shaving is completed. 

Orthopedic Skin Preparation 

First preparation — 48 hours before operation. 

Equipment 

Shaving tray plus sterile gauze flats. 
Sterile forceps in disinfectant solution. 
Orangewood stick for finger and toe nails. 



NURSING AND NURSING PROCEDURES 



275 



Saphenous 
ligation 





Chest operations 

J 




Mastoid 
operations 




Brain operations 



Thyroid operations 



Figure 315. — Areas of Skin Preparation for Operation. 



2/6 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Hand operations 



Foot operations 



Arm operations 




Abdominal and pelvic operations 



Leg operations 



Figure 316. — Areas of Skin Preparation for Operation. 



NURSING AND NURSING PROCEDURES 



277 



Nail brush. 

Sterile towels. 

Bandage, tape. 

Green soap, alcohol, ether. 

Procedure 

1. Shave area as described on chart. Use 
orangewood stick and brush for finger and toe 
nails (fig. 316). 

2. After area is shaved : 

Pick up gauze flats with forceps, pour green 
soap on gauze. 

Clean area, starting at one point and continu- 
ing until entire area is covered. Do not go back 
over any area twice. Repeat with alcohol. Re- 
peat with ether. 

Wrap area with sterile towels, keeping inside 
of towel sterile. 

Secure towels with bandage, adhesive tape 
around bandage. 

3. Twenty-four hours prior to operation: 
Repeat entire procedure. Doctor may order 

painting of the area with an antiseptic. If so, 
allow area to dry thoroughly before wrapping 
in sterile towel. 

Immediate Preoperative Preparation of the 
Patient (24 Hours Before) 

Modification of this routine will be made due to 
variety of operations, anesthetics, and preferences 
of doctors. Check doctor's orders ! 

Day before surgery 

1. Urge patient to take frequent rest periods, to 
drink plenty of water. 

2. Check laboratory work, see that all reports 
are on chart. Check to see if operative permit has 
been obtained. 

3. Light supper. 

4. Cleansing enema. 

5. Skin preparation of operative site. 

6. Complete bed or tub bath or shower. 

7. Hypnotic if ordered. 

Day of surgery 

1. Nothing by mouth. 

2. Early a. m. care. 

3. Take temperature and blood pressure; note 
record and report any signs of a cold (sore throat, 
sniffles, elevated temperature, cough, expectora- 
tion). 

211866°— 53 19 



4. Remove jewelry — wedding baud may be re- 
tained by patient and secured by a bandage passed 
through the ring and tied at the wrist. 

5. Remove prosthesis: 

Place teetli in cup; place eye in drawer of bed- 
side locker. 

Place leg in clothes locker (properly tagged). 

6. Female patients — remove bobby pins, combs 
from hair. "Wrap hand towel around head, secure 
in front of head with pin. Remove lipstick, nail 
polish (anesthetists watch lips and nails for signs 
of cyanosis). 

7. Reverse pa jama coat, omit pants. 

8. Have patient void one-half hour before go- 
ing to operating room. If patient is unable to 
void, notify doctor who may order catheterization. 

9. Prepare prescribed preoperative hypodermic, 
give as patient leaves for operating room unless a 
specified time has been ordered. 

10. Place patient on stretcher — cover carefully. 
The amount of covering will depend upon the 
distance the patient will have to travel to the 
operating room, the climate, and the condition of 
the patient. 

11. Send patient's chart. X-rays (if required) 
with patient. 

While patient is in operating room 

1. Provide for ventilation of bedside unit, pre- 
vent drafts by placing screen in front of open win- 
dow. 

2. Prepare recovery bed and top of bedside 
locker (see bedmaking). 

3. Move furniture to provide sufficient room for 
stretcher and other apparatus. 

4. Obtain other equipment. 
Shock blocks. 

Bottle, tubing, connecting tip if there is a 
possibility of drainage from operative site. 

5. Have intravenous infusion set-up, Wangen- 
steen appai'atus, or other apparatus that may be 
needed, in readiness. 

Postoperative Care 
Immediate 

1. Remove hot water bottles from bed if present. 

2. Roll hack top bedding. 

3. Assist with lifting patient from stretcher 
(three-man or draw-sheet carry). 



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HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



4. Place in position (according to doctor's 
orders). 

General anesthesia. — Patient flat in bed with- 
out pillow, head turned to one side. 

Spinal anesthesia. — Patient flat in bed or in 
shock position. 

Local anesthesia. — Patient may have head of 
bed elevated. 

5. From anesthetist : 

Find out type and nature of anesthesia and 
operation. 

Immediate postoperative orders — presence of 
drainage tubing. 

Locate and inspect dressing. Inspect fre- 
quently thereafter. 

6. Care: 

Take pulse, respiration, blood pressure at 
once and every 15 minutes until patient has re- 
acted. Pulse will usually be 10 to 20 beats above 
normal until recovery. Respirations will be 18 
to 24; watch for snorting, noisy respirations, 
dusky hue to skin (patient may be swallowing 
tongue) . Hold jaw up and forward (fig. 317a) , 
hold tongue with tongue depressor. Remain 
with patient until he is conscious. (If patient 
has an airway, remove it as he begins to respond. 
Figure 317b illustrates the curve of the airway ; 
when removing follow same arc to avoid in- 
juring patient's throat.) 





Connect drainage tubing if present. 
Inspect dressing frequently for signs of 
bleeding. 

When patient reacts 

1. Remove excess covering. 

2. If patient is groggy, place side bars on bed 
as safety precaution. 

3. Check working order of apparatus. 

4. If in pain give prescribed medication. Start 
sips of water by mouth if ordered and no nausea 
is present. 

5. Watch voidings. If patient does not void 8 
hours after last voiding, try measures to induce 
him to void. If patient is unable to void, notify 
doctor. 

6. Urge patient to take deep breaths every hour. 

7. Nausea and vomiting due to anesthesia should 
not last longer than 4 to 5 hours. If it does it 
may be due to idiosyncrasy to drug or complica- 
tions ; report to doctor. 

Later care 

1. Give basic nursing care plus medications 
and/or treatments ordered. 

2. Watch for signs of postoperative discomfort 
and complications. 

3. Encourage patient to help himself as much 
as possible. The patient may be permitted out of 
bed the day of operation or soon after. This gen- 
eral practice has shortened the length of hospital 
stay and hastened return to complete health. 

POSTOPERATIVE DISCOMFORTS 26 

Headache 
Causes 

1. Effect of anesthesia. 

2. Nervousness. 

3. Fatigue. 

4. Confusion. 

5. Excitement. 

6. Poorly ventilated room. 

Treatment 

Quiet, rest, fresh air, ice cap to head, hot 
water bottle to feet, medications if very severe. 



Figure 317. — (a) Holding Jaw. (b) Airway in Place. 



26 Adapted from Handbook of Hospital Corps — 1949 edition. 



NURSING AND NURSING PROCEDURES 



279 



Backache 
Causes 

1. Uncomfortable position on operating room 
table. 

2. Undue strain during surgery. 

3. Lying in one position too long. 

Treatment 

1. Careful lifting of patient. 

2. Frequent change of position. Urge patient 
to move about in bed. 

3. Alcohol back rubs (remove binders during 
back rub). 

4. Pillows for support — at back, between knees, 
under abdomen. 

Thirst 
Causes 

1. Dehydration. 

2. Preoperative hypodermic. 

3. Anesthetic. 

4. Profuse perspiration. 

Treatment 

1. Water by mouth, if allowed. 

2. Moisten lips with sponge dipped in cold 
water. 

3. Mouth wash. 

4. Chewing gum. 

Nausea and Vomiting 
Causes 

May be due to anesthetic or idiosyncrasy to 
drug. 

Treatment 

1. Deep breathing exercises to eliminate anes- 
thetic as soon as possible. 

2. Hypnotic or narcotic to rest patient, if 
necessary. 

3. Wangensteen suction drainage if ordered. 

Restlessness and Sleeplessness 
Causes 

Any of the above discomforts; pain, worry, re- 
action, etc. 

Treatment 

Above treatments, reassure patient, help him re- 
lax by alcohol back rub, straightening bed, shak- 



ing up pillows, morphine, or a barbiturate as 
ordered. 

Pain 
Causes 

1. Wealing off of anesthetic. 

2. Trauma from manipulations or manual pro- 
cedure during the operation. 

Treatment 

1. Change position if allowed. 

2. Use abdominal binder and pillows for sup- 
port. 

3. Prevent coughing or vomiting as much as 
possible. 

4. Administer hypnotic if ordered. 

Abdominal Distention With Accompanying 

Gas Pain 
Causes 

1. Shock from operation. 

2. Taut muscles. 

3. Remaining in one position too long. 

4. Sluggish peristalsis. 

Treatment 

1. Frequent change of position. Urge patient 
to move around in bed. 

2. Insert rectal tube if not oontraindicated. 
(Insert about 3 inches with the other end of tube 
in a urinal to prevent chance of soiling bed.) 

3. Hot water bottle to the abdomen if ordered. 

Hiccough (Singultus) 
Treatment 

1. Have patient breathe into paper bag held 
close to his face so that bag inflates and deflates 
with each respiration. 

2. If fluids are permitted — have patient take 
several large swallows of water while holding his 
breath. If these measures do not stop hiccoughs 
report to doctor. 

POSTOPERATIVE COMPLICATIONS 

Pneumonia 
Causes 

1. Infection carried to lungs from infected area 
of opera! inn. 

2. Aspiration of vomitus. 



2' 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



3. Irritation of lungs by anesthetic. 

4. Patient becoming chilled. 

5. Patient lying in one position too long. 

6. Result of a cold which patient, other patients, 
or personnel might have had. 

Symptoms 

1. Elevated temperature, increased pulse rate 
and some difficulty in respiration. 

2. Productive cough. 

3. Pain in chest. 

4. Symptoms usually appear on third day. 

Preventive measures 

All those listed under Treatment of Discom- 
forts. 

Treatment 

As ordered by doctor. 

Other complications 

Among other complications which may arise 
following a surgical operation are: intestinal ob- 
struction, peritonitis, tympanites, suppression of 
urine, retention of urine, infection, thrombo- 
phlebitis, or an embolus. These complications will 
be noted by the medical officers and appropriate 
treatment will be ordered for their relief. 

Peritonitis 
Symptoms 

1. Increase in temperature, pulse, and respira- 
tion. 

2. Patient appears toxic (general poisoning of 
blood due to absorption of bacterial products) . 

3. Sudden onset of abdominal pain. 

4. Tender, rigid, board-like abdomen with dis- 
tention. 

Treatment 

1. Fowler's position — to localize inflammation. 

2. If wound is draining, frequent change of 
dressings. 

3. Insertion of rectal tube if ordered. 

Tympanites 

Paralysis of the peristalsis, with distention of 
the abdomen, due to gas and feces (alertness and 
good nursing may prevent this condition ) . Watch 
for signs of distention, and begin treatment before 
serious trouble begins. 



Symptoms 

1. Abdominal pain and discomfort. 

2. Abdominal distention. 

3. Respiratory difficulty. 

4. Increased pulse and respiration rate. 
Treatment 

1. Urge patient to move about in bed. 

2. Change patient's position frequently. 

3. Insertion of rectal tube if ordered. 

Suppression of Urine (Failure of Kidneys 

to Function) 
Symptoms 

1. At first urine is scanty. 

2. Headache, dizziness, impaired vision, nausea, 
restlessness. 

3. Puffiness under the eyes. 

4. Later urine is entirely absent; odor of am- 
monia to breath. 

5. Patient becomes delirious, drowsy, has mus- 
cular spasm. 

6. Patient has convulsions, coma, and death — 
unless he responds to treatment. 

Retention of Urine (Inability to Void) 
Methods to induce urination 

1. Give warm drinks or small amounts of hot 
water. 

2. Let patient hear the sound of running water. 

3. Let patient immerse hands in warm water. 

4. Hot water bottle over bladder area. 

5. Enema or Sitz bath — only on order from 
doctor. 

6. Allow to sit or stand on side of bed — requires 
doctor's order. 

Infection 
Causes 

1. May be due to conditions existing before 
operation. 

2. May be due to bacteria introduced into wound 
during or following operation — may be local or 
general. 

Symptoms 

1. Sharp rise in TPR. 

2. Abdominal pain or discomfort in area of 
operation. 

3. Abdomen may be distended. 

4. Drainage from incision. 



NURSING AND NURSING PROCEDURES 



281 



Intestinal Obstruction 
Symptoms 

1. Abdominal distention. 

2. Frequenl vomiting in small amounts, 

8, Sharp colicky abdominal pain with intervals 
of no pain. 
4. Hiccoughs. 

Treatment 

1. Frequent change of position. 

2. Wangensteen, Lf ordered. 

3. May require surgical intervention. 

Thrombophlebitis 
Symptoms 

1. Cramp-like pain, and/or swelling of the limb. 

'2. A lump may or may not be felt under the skin 
in painful area. 



Treatment 

1. Do not rub, massage, or bathe limb. 

2. Elevate limb on pillow — keep the pal ient and 
the limb at ease. 

3. Immobilize the limb with sandbags or pil- 
lows. 

4. Application of heat — dry or moist as ordered. 

Embolus 
Symptoms 

1. Sudden onset, collapse. 

2. Pain in chest. 

3. Acute sudden respiratory distress. 

Treatment 

1. Complete bed rest — Fowler's position. 

2. Oxygen therapy. 



THE CARE OF THE PATIENT ON THE ORTHOPEDIC SERVICE 

Review — Chapter II, "The Skeletal System" 

"The Muscles" 

Unit II, "Basic Nursing Care" 



Patients on the orthopedic service are those who 
require treatment of fractures, deformities and 
diseases of the musculo-skeletal system. Some 
patients require surgery and immobilization to 
Correct their conditions, others require immobili- 
zation, bed rest and re-education. 

The usual orthopedic patient is in good general 
physical condition and is a bed patient oidy be- 
cause the treatment prescribed for his local con- 
dition limits his movements. This patient usually 
is a long-term patient, his hosiptal stay may ex- 
tend over many months. 

The care of the orthopedic patient may be con- 
sidered as being in two stages: 

1. The period of immobilization — when the pa- 
tient is in a cast, traction, frame or brace. Sound 
basic nursing care at this time is most important. 

2. The period of rehabilitation — when the pa- 
t ient re-learns how to use his muscles under the di- 
rection of the physical medicine department. Co- 
operation of the nursing personnel with the physi- 
cal medicine department is most important at this 
time. 



What the Corpsman Should Know 

1. How to take care of the patient with the ap- 
pliances used for his treatment. 

2. How the patient's orthopedic condition 
limits his movements. 

3. The amount and type of activity the patient 
is permitted. 

4. The amount and type of treatment the pa- 
tient is receiving in other departments. 

THE PATIENT IN A CAST 

Casts may be applied to extremities to immo- 
bilize one or more joints. ExamfiU : below knee 
cast to immobilize ankle joint : above knee cast 
to immobilize ankle and knee joints. Casts may 
be applied to the body to immobilize lower trunk 
and one or both legs: to immobilize head and 
upper trunk or to immobilize trunk only. 

Assisting with application of plaster casts 

Equipment 

Examining table. 
Buckets of tepid water. 



282 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Large bandage scissors. 
Rolls of plaster bandage of desired width, ac- 
cording to doctor's preference. 

Stockinet or sheet wadding. 

Felt padding. 

Newspaper. 

Procedure 

Preparation of patient and unit: 

1. Explain the procedure to the patient. 

2. Cleanse and thoroughly dry the part to be 
encased. 

3. Spread newspaper on floor under and around 
table. 

4. Place the patient in position desired by 
doctor. 

Preparation of plaster: 

1. Remove paper wrapper from roll. 

2. Place roll on end in bucket. Allow roll to 
remain undisturbed in water until bubbles stop 
rising. 

3. Grasp both ends of roll, lift from water and 
slowly squeeze until water stops dripping from 
roll. Do not twist roll. 

4. Prepare rolls so that two or three are soaking 
while one roll is being applied. 

5. Change water in buckets after every six to 
eight rolls. (When water is too heavily saturated 
with plaster the rolls do not soak properly.) 

6. Method of application 

Part to be encased is covered by stockinet or 
sheet wadding. 

Felt pads are cut to fit bony prominences. 

Doctor applies plaster rolls while corpsman 
holds part in desired position. 

The patient remains on the table until cast is 
set. 
Immediate care — First 24 hours: 

1. Prepare the bed for the patient. 
Place fracture board under mattress. 

Place rubber covers on pillows to be used to 
support cast. 

2. Lift patient carefully from stretcher to bed. 
Do not roll patient. 

3. Use the palms of hands when lifting a damp 
cast. Avoid using fingers — fingers cause depres- 
sions in cast which 'in turn cause pressure areas. 

4. Place the encased part on rubber covered pil- 
lows. Support the cast its entire length. 

Cast on extremity — support on inclined plane. 



Cast on body — use enough pillows to support 
the entire body. 

5. If cast is on an extremity — leave it exposed. 
If cast is on the body, screen patient, cover the 
pubes and leave cast exposed after patient has 
completely recovered from anesthetic or shock. 

6. Watch patient closely. 

If patient has had surgery — treat as a post- 
operative patient. Be alert for signs of shock or 
hemorrhage. 

All patients — report any complaint of pain 
or pressure at once — do not wait! 
Cast on extremity 

Inspect fingers or toes of the encased extremity 
frequently for pallor, blueness, swelling, or cold- 
ness. Does the skin show a slow return to pink 
where you press it with your fingers ? 

Take the pulse of exposed fingers or toes of the 
encased extremity. 

Does the patient complain of a burning sensa- 
tion ? Does the patient complain of tingling, pres- 
sure, pain? What is the location of complaint? 
Cast on body 

Is the cast pressing anywhere : on chest, groin, 
buttocks, or knee? 

Does the patient have difficulty breathing? 

7. Quick drying or baking should not be at- 
tempted without a doctor's order and until after 
the cast is set. (Cast may dry on the outside and 
patient may be burned by the moist heat generated 
inside the cast.) A cast may take from several 
hours to 2 to 3 days to dry completely. 

Later care 

1. Patient with cast on arm or leg : 

Turn patient every 2 hours to allow all parts 
of the cast to dry. 

2. Patient with body or spica cast : 

Turn the patient for the first time 6 to 8 hours 
after application of the cast, then every 2 hours. 

To turn the patient: Slide the patient on 
the pillows to the side of the bed. (Spica — 
always turn with operated hip uppermost.) 

Place rubber-covered pillows along the 
length of the cast. 

Ask the patient to raise his arms above his 
head. 

With help and at signal turn the patient 
over on his abdomen onto the pillows. 



NURSING AND NURSING PROCEDURES 



283 



Fold a pillow and place it under the feet to 
relieve pressure of toes on the bed (in spica 
cast, one foot should he off the mattress when 
patient is on his abdomen). 

Protect the cast about the buttocks and 
perineal area with oiled or plastic material. 
Check condition of patient's skin under the 
cast frequently. 

Be alert for possible pressure sores. 
Reach under cast while patient is on his 
abdomen and wash his buttocks and back; 
rub well with alcohol. 

Smell the cast frequently for moldy, putrid, 

or other abnormal odors. Pressure areas may 

often be first detected by odor. 

Check supports; is the patient's entire body 

supported on the same plane as the encased 

parts? 

( 'heck elimination ; abdominal distention and 
constipation are fairly common complications 
for the first week after a body cast is applied. 

3. Smooth rough edges of cast after it is com- 
pletely dry : 

Pull out stockinet lining and tape it to the 
ouside of the cast, or petal edges: 

Cut 2-inch adhesive in 12-inch strips. 

Fold tape lengthwise, cloth sides together. 

Cut 2-inch pieces at 45° angles. 

Open petal, place single point outside cast, 
double point inside cast. Overlap petals about 
entire edge of cast. 

4. Watch for signs of cast cracking. 

5. Encourage the patient to exercise as much as 
possible in preparation for crutch walking. These 
bed exercises may be in the form of lifting dumb- 
bells, doing "pull ups" on the balkan frame 
trapeze, or "push ups v on bed. 

To remove a cast 

1. Transfer the patient to a stretcher or table 
if possible. 

2. Place newspapers or rubber sheet under the 
cast. 

3. Moisten cast along the cutting line with 
hydrogen peroxide or vinegar (apply solution 
with a medicine dropper or bulb syringe). 

- 4. Cut cast. 

5. Remove top half of cast, return patient to 
his bed. 



(>. Lift limb out of cast, place limb on pillows, 
supporting its entire Length. 

After cast is removed 

1. Remove all plaster crumbs from bed. 

2. The limb will probably be covered with a 
yellow crust and be odorous. Avoid attempting 
to remove this crusl by vigorous scrubbing or rub- 
bing, it is a protection for the skin. Gently wash 
the limb with a mild soap and water. If a new 
cast is not to be applied, cocoa butter or a similar 
substance may he used to soften this exudate. 

3. The patient may complain of soreness and 
discomfort in the limb for several days after the 
cast is removed. This is because the muscle- of 
the limb are weak and have lost the support of the 
cast. 

4. The cast shell may be used to support the limb 
at night. If so, smooth rough edges of cast, re- 
place lining, clean cast. Montgomery straps may 
be used to hold the cast in place. 

THE PATIENT IN TRACTION 

Types of traction 

Skeletal — traction is applied directly to the bone 
by tongs, pin, or wire connected to weights and 
pulleys. 

Skin traction is applied to the skin by the use 
of heavy adhesive tape connected to weights and 
pulleys. 

Preparation of patient and his unit 

1. Place the patient in a bed having a fracture 
board under the mattress and a balkan frame over- 
head. 

2. Check with the doctor as to the type of splint, 
frame, attachments, and traction he will use. If 
skeletal traction is to be used, the area is prepared 
as for a surgical operation. I f skin traction is to 
be used the area should he shaved. Tincture of 
benzoin may be applied to protect the skin and 
improve the sticking qualities of the adhesive. 

3. Bring the orthopedic cart and other neces- 
sary equipment to the bedside. 

4. Assist the doctor as required. 

After traction is applied 

1. The angle of traction must he maintained. 
Shock blocks under the head or foot of the bed 
may he used to keep the patient in position. 



284 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 318. — Patient in Traction. 

2. The weight of traction must be maintained. 
Check weights frequently. Are the weights hang- 
ing free ? Are the ropes in the pulley groove ? 

3. Traction on arm or leg : 

Is the hand or foot supported? The foot 
should be at a right angle to the leg, hand should 
be supported in a functional and correct ana- 
tomical alignment. 

Check adhesive in skin traction. Is it slip- 
ping? Is it wrinkled? Check the pins or 
wires and condition of the skin in skeletal trac- 
tion. Are the pins resting on the splint ? Are 
the ends of the wire covered by corks or ad- 
hesive ? 

Support the free foot by a footboard. 

4. The patient should be comfortable once the 
traction is applied. If he is not, something is 
wrong. Recheck items listed in this section and 
refer to the "Check list relating to the comfort of 
the patient" for additional possible causes of his 
discomfort. 

5. Encourage patient to do bed exercises in 
preparation for crutch walking. 

Crutch Walking 
Types of crutches 

Aluminum cane type — has mid-forearm sup- 
ports. Height is adjusted in shaft of crutch. 

Wooden type — has axillae and hand bars. 
Height is adjusted in shaft and hand bars of 
crutch. 



Measurement of crutches 

Aluminum cane type: Have patient stand 
against a wall; adjust height of crutch so that 
when patient leans on crutch his elbows are in 30° 
flexion, hands are flat on hand bars, and crutch is 
4 inches out from the side of his heel. 

Wooden type : Have patient lie flat in bed, hands 
at sides; using a tape measure, measure from the 
border of the axilla to 6 inches out from the side 
of his heel ; adjust height of crutch to this meas- 
urement; place crutch in same position you had 
tape measure; ask patient to place his arm over 
the crutch and grasp hand bar so that patient's 
elbows are in 30° flexion and the palm of hand is 
flat on hand bar. 




Figure 319. — Aluminum Cane 
Type Adjustable Crutch. 



Figure 320. — Wooden 
Adjustable Crutch. 



Teaching the patient to use crutches : 

The type of crutch-walking the patient is to use 
will be ordered and demonstrated by the doctor. 
It will depend upon whether or not the patient is 
permitted to bear weight on the injured leg, and 
whether crutches will be used temporarily or over 
a long period of time. Whenever possible, crutch- 
walking should be taught by the physical medicine 
department. 



NURSING AND NURSING PROCEDURES 



285 



1. The most common type of crutch-walking for 
short-term use is the "swing through" gait. The 
patient bears weight on his good leg, places the 
crutches at an equal distance ahead of him and 
then swings to a position just ahead of the 
crutches. Weight is shifted to the hands and then 
back to the good leg. 

2. Allow patient to practice bearing his weight 
on the palms of his hands while standing at the 
side of the bed. 

3. Stand in back of the patient when he is learn- 
ing to use crutches. If he begins to fall, bring 
him back against your body for support. 



Caution patient 

1. To wear shoes when crutch-walking. 

2. To try to establish a rhythm, take small steps 

and to look straight ahead when walking. 

3. To place crutches ahead and to the side of bis 
body to provide a broad base of support. 

4. To bear weight on palms of hands, not on the 
arm rests. ( Paralysis of the radial nerve may re- 
sult if weight is borne on the axillae.) 

5. To avoid wet, slippery or highly waxed floors. 

6. To use the crutches for short periods of time 
and for short distances until he is accustomed to 
them and does not become tired. 



SUGGESTED ADDITIONAL READING— UNIT IV 



The Control of Communicable Diseases in Man. 

7th ed. New York : The American Public Health 

Association, 1950. 
Eliason, Eldridge, Ferguson, L. Kreer, and 

Sholtes, Lillian. Surgical Nursing. 9th ed. 

Philadelphia : J. B. Lippincott Co., 1950. 
Funsten, R. V., and Calderwood, Cormelita. 

Orthopedic Nursing, 2d ed. St. Louis: C. V. 

Mosby Co., 1951. 
Jensen, Julius, and Jensen, Debroah Maclurg. 

Nursing in Clinical Medicine. 3d ed. New 

York: Macmillan Co., 1949. 
McCulloch, Ernest C. Disinfection and Sterili- 
zation, 3d ed. Philadelphia : Lee and Febiger, 

1948. 



Montag, Mildred, and Filson. Maroaret. Nurs- 
ing Arts. Philadelphia: W. B. Saunders Co., 
1948. pp. 74-94; 338-408. 

Safer Ways in Nursing. New York : Prepared by 
Joint Tuberculosis Nursing Advisory Service of 
the National Tuberculosis Association and the 
National League of Nursing Education. 1948; 

Wolf, Lulu K. Nursing. D. Appleton-Century 
Co., Inc., 1947. pp. 308-325. 

Young, Helen, Lee, Eleanor and Associates. Es- 
sentials of Nursing. 2d ed. rev. New York: 
G. P. Putnam's Sons, 1948. pp. 439-498. 
Read the current issues of periodicals for the 

latest information on the care and treatment of 

your patient. 



Periodicals available 
Journal of Nursing. 



at most stations: Armed Forces Medical Technicians Bulletin and 



WARD MANAGEMENT— UNIT V 
Review, Manual of Medical Department, Chapters 1 1 and 22; Local Station Orders 



A ward is a unit of a hospital composed of a 
number of beds and other equipment necessary to 
provide service to and for the patients assigned to 
it. 

Ward management is the direction, guidance, 
and supervision of ward personnel and their activi- 
t lea t oward the goal of giving the best possible care 
to the greatest number of patients. 

The management of a hospital ward is ordi- 
narily the delegated responsibility of a nurse corps 



officer. In executing her responsibilities as ward 
manager, the nurse corps oilicer: 

1. Defines and assigns duties to the corpsmen 
and patients by means of detail lists. 

2. Establishes routines and schedules for ward 
activities. 

3. Keeps records and reports as required by the 
Manual of the Medical Department and local hos- 
pital ori 



;> 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



4. Maintains adequate supplies and equipment 
on the ward. 

In a sick bay aboard ship or in the absence of 
a nurse corps officer, the responsibility for ward 
management is delegated to the senior hospital 
coi'psman present. The management of a sick bay 
follows the same general pattern as that of a ward. 

Detail list. — A corpsman's detail list is made 
out and posted on the bulletin board. The list 
should : 

1. Be clear, concise, and complete. 

2. List all ward activities (patient care, house- 
keeping, errands, relief, etc ) . 

3. Divide the activities into evenly distributed 
work loads equal to the number of corpsmen as- 
signed to the ward. 

4. Assign each corpsman according to his ability 
and experience. 

5. Rotate assignments so that each corpsman 
will gain experience in all phases of patient care 
available on the ward. 

Orientation of a new corpsman to the ward 

1. Introduce him to his fellow workers. 

2. Take him around the ward; introduce him 
to the patients and show him where supplies and 
equipment are stored. 

3. Find out what experience he has had, what 
experience he lacks. 

4. Discuss the ward routines, detail lists, and 
assignments with him. 

5. Supervise his work closely until he demon- 
strates his ability to carry out assigned duties de- 
pendably. 



WARD ROUTINES AND SCHEDULES 

Each ward will necessarily have to adopt rou- 
tines and schedules according to the type of pa- 
tients assigned to it. It is recommended that the 
routine for medications and treatments as out- 
lined be adopted and adapted to all situations 
where practicable. 

Sample routine of the ward during the day 2T 
0700-0800 Serve breakfast. 

Turn off unnecessary lights. 

Make out necessary ward records (per- 
son in charge of ward) . 

" Adapted from Hospital Corps HaDdbook, 1949. 



Prepare all records, reports for doc- 
tor's signature at sick call. 
0800 Start morning care to patients, such 
as baths, treatments, and medica- 
tions. 
Start patients' cleaning details. Be- 
gin in doctor's office, examining 
room, etc., and work toward ward 
proper. 
0900 Morning sick call by ward medical 
officer, nurse corps officer, senior 
hospital corpsman. Carry out 
"stat" orders. Other corpsmen 
carry on assigned duties. 
1100 Weather permitting, ventilate ward; 
protect patients from drafts. 
1130-1230 Serve dinner. Ward corpsmen go to 
dinner. One-half of crew goes each 
period. 
1300-1400 Rest hour for patients. Check charts, 
orders, and make out specimen 
requests. Write ward report book. 
1400-1600 Visiting hours. Carry out necessary 

nursing care of patients. 
1630-1700 Serve supper. 

1800 Evening care to bed patients. 
1900 Evening sick call — Officer of the day, 
nurse corps officer, and senior corps- 
man. Carry out "stat" orders. 
2000 Distribute specimen containers; start 
settling ward for the night. 
Distribute bedpans and urinals to bed 

patients as needed. 
Distribute extra blankets. 
Adjust windows for ventilation. 
Turn out overhead lights; turn on 

night lights. 
Check patients for any last minute 
needs. 
2045 Check and see that head, shower, linen, 
utility and ward galley are clean 
and in order. 
2100 Give report and special orders to re- 
lieving night corpsman. 
Off duty. 



NURSING AND NURSING PROCEDURES 



287 



Sample routine of the ward during the night 
(duties of the night corpsman) 

2050 Report for duty. Receive report from 
day corpsman and p. m. nurse corps 
officer. 

Discuss and understand all reports, 
orders, and duties. 

Make actual bed check against ward 
roster and liberty list. 
2100 Send muster report to night master at 
arms. 

Start night log. 

Chock orders with night nurse corps 
officer; find out how to contact her 
when needed; notify her of any pa- 
tient's complaints, change in condi- 
tion, any unusual happening on 
ward. 
2130 Organize work for the night. Note 
or make a memorandum of medica- 
tions, treatments, nursing care to be 
given during the night, cleaning de- 
tails (hypo, thermometer trays; 
solarium; dressing cart) to be done. 

Plan to make frequent rounds dining 
the night. At least hourly on entire 
ward and more often to seriously ill 
patients. 

Record in night log after each round. 
Record in patient's charts all ob- 
servations a> they occur, medica- 
tions and treatments after they are 
given. 
0100 First watch to supper. 
0130 Relief watch to supper. 
0400 Quietly organize work and equip- 
ment for morning care. 
0600 Lights on. Reveille. Morning care to 
bed patients. 

Medications and treatments as or- 
dered. Collect specimens: check off 
those collected in report book; 
record on patients 7 charts. 

Complete and sign night log and 
patients' charts*, 

Square away service rooms, desks, 
nurses' station. 
0700 Give report to day corpsmen. 

Take specimens to laboratory. 

Off duty. 



Sample routine of corpsman on special watch — 
night duty 

2050 Report to nurse corps officer. 

Receive and understand patient's 
orders. 
Take complete care of the patient. 
Make a memorandum of medication- 
and treatments, nursing care to be 
given, observations to be made. 
Check your plan of care with the 

nurse officer. 
Start patient's chart. Record all ob- 
servations, medications, and treat- 
ments as they occiii- or are given. 
(See "The seriously ill or dying 
patient.") 
0130 To supper when properly relieved. 
0600 TPR. medications and treatment- as 
ordered. 
Give complete bath, change linen, and 
clean and square away room or unit. 
0645 Complete and sign patient's chart. 
0700 Give report to relief corpsman and day 
nurse corps officer in charge of 
ward. 
Take specimens, if any. to laboratory. 
Off duty. 

Note. — The routine of corpsman mi special watch dur- 
ing the day follows the same general outline. 

Sample Cleaning Schedules of the Ward 
Daily cleaning — Decks 

1. Sweep down after meals, using sweeping com- 
pound. Swab stone, unpolished wooden and lino- 
leum decks. 

2. Buff decks each morning. 

3. Scrub shower and head deck- each a. m. and 
p. m. 

1. Scrub galley deck each a. m. and p. m. 

Bedside units 

1. Damp dust lockers, beds, chairs, lamps, win- 
dow sdls each a. m. 

2. Line up beds, chairs, lockers each a. m., p. m., 
p. r. n. 

Service rooms 

1. Clean sinks, hoppers, working surfaces each 
a. m. and p. m. 

2. Swab decks each a. m. and p. m. 



288 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Weekly cleaning — Monday 

1. Routine daily cleaning. 

2. Damp dust vents, signal buzzers. Dust elec- 
trical fixtures. 

3. Clean radiators, electric fans. 

4. Clean wheel chairs and special equipment. 

Tuesday 

1. Routine daily cleaning. 

2. Wash beds, springs and mattresses, chairs, 
inside and outside of lockers. 

3. Polish bright work. 

Wednesday 

1. Routine daily cleaning. 

2. Dust screens with a brush. 

3. Wash windows and Venetian blinds. 

4 Dust walls with cleaning cloth attached to a 
long-handled broom. 

Thursday 

Field day — any day before inspection. 

1. Routine daily cleaning — wax decks. (Ex- 
ception: orthopedic wards.) 

2. Clean medicine lockers, cabinets, desks, cup- 
boards. 

3. Wash stretchers, wheel chairs, irrigating 
stands, screens, overbed tables. 

4. Clean gear, gear lockers, racks. Swabs 
should be "twirled and spread out" to dry (in sun 
if possible). Clean brooms and dust pans. 

5. Check all cleaning details. 

Friday 

1. Routine daily cleaning. 

2. For captain's inspection, open locker, cab- 
inets, desk drawers. Line beds, chairs, lockers. 
Open windows evenly ; line up Venetian blinds and 
shades. 

Saturday and Sunday 

Routine daily cleaning. 

Ward routine and cleaning schedules may be 
modified in different stations due to local condi- 
tions. 

Sample Routine For Inspection 

Ward is in order and all patients are present 
unless excused by ward medical officer. 



Ward medical and nurse officers and senior 
corpsmen stand at entrance to the ward. Other 
personnel continue with assignments. 

Duties of Senior Corpsman: 

1. Stand at entrance to ward equipped with a 
flashlight, ward keys, and a hand towel 
dampened with water at one end. 

2. On arrival of the inspection party, call the 
ward to attention. 

3. Precede the inspection party ; turn on lights, 
open doors as the party progresses through 
the ward. 

a. Adjust the pace of the inspection to the 
desires of the inspecting officer. 

b. Offer the dampened towel for the inspect- 
ing officer's hands when needed. 

c. Be prepared to answer questions concern- 
ing the patients and the ward. 

d. Be attentive to all suggestions made by the 
inspecing officer. 

e. Escort the inspection party to the exit of 
the ward. 

4. When the inspection party has left the ward, 
announced "Carry on." Continue with ward 
routine. 

WARD RECORDS AND REPORTS 

Ward records and reports may be classified into 
two groups : 

1. Records and reports used in the internal oper- 
ation of the ward, such as : 

Ward Report Book. 

Doctor's Order Sheets. 

Report at Change of Watch. 

Ward Roster. 

Diet List. 

Narcotic Book. 

Temperature-Pulse-Respiration Book. 

2. Records and reports prepared by the ward 
for other departments : 

Ward Report. 

Diet Sheet. 

Laundry List. 
Consult the station orders for any additional 
records or reports required and for the disposition 
of completed records or books as prescribed by the 
local station. 



NURSING AND NURSING PROCEDURES 



289 



Records and Reports Used on the Ward 

Ward report book. 

Purpose : To provide a record of ward activil ies 
for the information of corpsmen, doctors, and 
nurses. 

Indicated for all wards. 

Contents 

Census and changes in census. (Heading.) 
Condition of patients. (Body of Report.) 

Suggested form 

Headings 

Ward. Date.. 



Census @ 0700 



@ 1500 



@ 2200 




Watch List 
Port 

0800-1200 (Names) . 

1000-2100 

Starboard 

0700-1600 



Night 

2100-0700 



(0700 (Signatures) NC 

Narcotics.. ^1500 NC 

12200 NC 


P. M. SickcaU 

(Signature) 

O. O. D. 


A.. 


(Name) 


(Rank or Rate) 


(Diagnosis) 




AOW 
TOW 


J(Xame) 


(Rank or Rate* 


(Diagnosis) 


From Ward 

to Ward 


1) 


(Name) 


(Rank or Rate) 


(Diagnosis) 




PAL. 


(Name) 


(Rank or Rate) 


(Diagnosis) 


Date 


AOL 


(Name) 


(Rank or Rate) 


(Diagnosis) 


Date 



Body of Report 

1. Record patients on the critical and serious 
lists, new admissions, and others requiring special 
care. 

2. List their conditions, nursing care required, 
and any special information the other watches 
should know. 



Port 
1 
C L. 

Sp. w. 



EXAMPLE 

Jones, John J. HA Diagnosis 

1. Appeal's slightly improved. 

2. Give oral hygiene and back care q2h. 

3. Change position q2h. 

4. Restrict visitors to parents. 

5. Watch voidings; measure and record 

intake and output. 

6. Patient is allergeic to codeine! 



3. List names and bed numbers of the patients 
who are to have a. m. care; are to have specimens 
collected: are to have special tests requiring de- 
layed breakfasts, etc.: require special care. 

4. Record any unusual happening on the ward 
(patient falling out of bed, fist fights, etc.). 

5. Night watch will record after each round: 
changes in patient's condition; completion and 
check-off of assignments listed in 3 above; names 
of unauthorized absentees. 

6. Ward Report Book must be signed by the 
person in charge of the ward (nurse officer or 
senior corpsman) on each watch. 

Doctor's Order Sheets 

Purpose: To provide a method for obtaining 
and executing the doctor's orders. 

Equipment 

1. Doctor's order sheets for all patients on the 
ward. 

2. Manila folder or chart back. 

3. Paper clips. 

4. Metal marking tabs. 

5. Alphabetical file tabs. 

Procedure 

1. Place doctor's order sheets in alphabetical 
order in a manila folder or chart back. 

2. Place a blank sheet of paper on top of folder. 

3. Keep this folder on the nurse's desk. 

4. When the doctor writes and signs an order on 
the patient's order sheet, the patient's name is writ- 
ten on the blank sheet. 

5. The corpsman or nurse officer initials the or- 
der on the order sheet and crosses the patient's 
name off the sheet on top of the folder when the 
order is noted and executed. 

6. Use paper clips to mark those order sheets 
containing new orders. 

7. Use metal marking tabs to mark the order 
sheets of patients who are on the C. L. or S. L. 
lists. 

Sample Report at the Change of Watch 

Purpose: To report the ward activities and the 
conditions of the patients to the personnel of the 
new watch present for the report. 

Equipment 

1. Ward report book. 

2. I)(" order sheets. 



290 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Procedure 

1. Have nurses' station quiet and in order. 

2. Have all personnel of the new watch present 
for the report. 

3. Use both the report book and the doctor's 
order sheets. 

4. Give the status of the ward from the headings 
of the ward report book. 

5. Report all new orders directly from the doc- 
tor's order sheets. 

6. Give any other information the new watch 
will need to know. 

7. Discuss problems or procedures which have 
arisen or may arise. 

Remember the team carries on for the entire 24- 
hour period ! 

Ward Roster 

Purpose: To maintain an accurate list of all 
patients on the ward. 

Equipment 

1. Cardex file. 

2. Admission cards (NAVMED 1285). 

3. Bed numbers. 

Procedure 

1. Label cardex file pockets with the bed num- 
bers on the ward. Number beds starting at left of 
entrance to ward. Uneven numbers designate left 
side of ward ; even numbers right side of ward. 

2. Place patient's admission card in cardex 
pocket corresponding to his assigned bed number. 

Diet List 

Purpose: To serve the proper food to each 
patient. 

Equipment 

1. Blank sheet of paper, or 

2. Blackboard in diet kitchen^ 

Procedure 

1. List all patients who are to be fed on the ward 
and in the mess hall. 

2. List patients under the appropriate columns. 

3. List type of diet under special diets. 

4. Designate those patients who are to have 
nourishments by a capital "N" after their names. 



Sample Form 



Ward 

On ward 






Date 
Mess hall 


Reg. 


Light 


Soft 


Liquid 


Special 

















Narcotic Book 

Purpose: To maintain a permanent accurate 
record of narcotics on the ward. 

Equipment : The narcotic book may be a 5 x 8 
or 10 x 14 ledger book. Its pages should be 
divided into columns for date, hour, patient's 
name, each narcotic on ward, doctor's name, nurses' 
name. 

Each narcotic charged to the ward must be ac- 
counted for and an entry must be made in the 
book: 

1. Each time a new supply is received from the 
pharmacy. 

2. Each time a narcotic is given. 

3. Each watch following a complete narcotic 
count. 

4. Each week showing totals of narcotics re- 
ceived, dispensed, and remaining on hand. These 
totals must balance. 

Temperature-Pulse-Respiration (TPR) Book 

Purpose: To provide a temporary record of 
the temperatures, pulses, and respirations (TPR) 
of all patients on the ward; to use when taking 
temperatures, pulses and respirations. 

Equipment : The TPR book may be a 5 x 8 or 
10 x 14 ledger book, depending upon the number 
of patients on the ward and the frequency in which 
recordings must be made. 

Procedure 

1. Place name of ward and date at top of page. 

2. Rule page into columns for bed number, 
name of patient, and the number of columns 
needed for recording the temperature, pulse, and 
respiration. 

3. List bed numbers in numerical order. 



NURSING AND NURSING PROCEDURES 



291 



4. List patients' names according to their place- 
ment on the ward. 

5. Place a check mark next to the patients' 
names who are to have <|lh or <)id recordings. 

Use of Book: 

1. Record all TPR's. 

2. Circle elevations of temperatures of 100° F. 
or over with red pencil. 

Records Prepared For Other Departments 

Ward Report (Nav Med HF 9) 

Purpose: To provide a correct daily patient 
census; to show a daily change in census. 

Indicated: For all wards. 

Send to record office by 0830 daily. — The ward 
report is used as a basis for rilling out Form 10 
by the record office. It may also be used by the 
agent cashier for meal checkage. The report must 
be accurate, complete and legible. The report 
covers a 24-hour period (0001-2400). The head- 
ing of the report shows the numerical census and 
change in census. The body of the report lists the 
names, rates and diagnoses of the changes which 
occurred in the previous 24-hour period. Both 
sections must be in complete agreement. The 
"census last report" must agree with the total re- 
maining from the last ward report. All changes 
in the patient census should be listed as they occur. 
Check station orders for any additional informa- 
tion required at your station. 

Diet Sheet (Nav Med HF 18) 

Purpose: To obtain adequate foods from the 
commissary for the patient. 

Indicated : For all wards. 

Send to diet kitchen by 0830 daily. — Be sure 
to order enough diets for all your patients but do 
not pad the requisition. Fill in the top section 
of the sheet as directed on the form; specify the 
number of patients eating on the ward or in the 
mess hall for all diets. In the body of the report 
list by name those patients on other than regular 
diets. Specify type of special diet and whether 
it is to be served on the ward or in the mess hall. 

In some stations a "cripples" mess" is main- 
tained. If such is the case, list the names of those 
patients who are to eat in this mess. 



Check station orders for additional information 
required on sheet and directions for ordering 
nourishments and staples. 

Laundry List 

Purpose: To order linen from linen room. 

Indicated: For linen exchange on days speci- 
fied in station order-. 

Send to linen room on days and at time- 
specified. 

The laundry list is made out in duplicate. The 
original goes to the laundry or linen room with 
the soiled linen. The copy is retained by the 
ward. The linen is counted and totals placed in 
appropriate columns. The linen returned from 
the linen room is checked against the ward copy 
of the laundry list. Cleaning cloths, binders, and 
other items of linen not listed are written in on 
blank sections of the sheet. 

WARD SUPPLY AND EQUIPMENT 

The supply and equipment for ward use is clas- 
sified as follows: 

Expendable — Those items that are consumed in 
use, break easily or are inexpensive, such as paper. 
glassware, plastic drinking tubes. 

Nonexpendable — Those durable items, such as 
furniture, instruments, vehicles. 

Ordering Supplies and Equipment 

Expendable items are ordered on the supply 
requisition (NavMed 1342) at the times specified 
in the local station orders. The form is self-ex- 
planatory. 

Request sufficient amounts to last until the 

next ordering day. 

Base order on the rate of use of the item. 
Know the number of items in each ordering 

unit. 

Example: The order in g unit for "Ward Report" 
is 1 pad. Each pad contains l 1 '" report blanks; 
therefore 1 unit should be enough for a 3-month 
supply. 

.V on expendable items are ordered on the "Equip- 
ment Voucher" Form 111) when new equipment 
is desired, when equipment is returned to the store- 
room orwhen t is surveyed for repair or disposal. 
The form i self-explanatory. 



292 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Care and Use of Supplies and Equipment 

All ward personnel and patients are charged 
with the conservative use of government mate- 
rials. The custody of nonexpendable items is 
charged to the ward medical officer but all per- 
sonnel and patients should endeavor to keep this 
equipment on the ward and in good condition. 

Metalware 

General instructions 

1. Rinse with cold water. 

2. Wash with warm soapy water. 

3. Boil 20 minutes. 

4. Use mild scouring powder or sand soap for 
removing stains. 

5. Rinse with hot water ; dry. 

6. Stow in proper place. 

Bedpans and urinals 

1. Cleansing by automatic bedpan sterilizers. 

a. Place in apparatus ; push flush lever. 

b. After flush, press steam lever for one min- 
ute. 

c. Carry out steps 4—6 in general instructions 
above. 

2. Manual cleansing. 

a. Rinse with cold water. 

b. Clean with brush and soap solution under 
running water. 

c. Rinse well with hot water. 

d. Boil in utensil sterilizer 20 minutes. 

e. Stow in rack. 

Instruments 

1. Rinse in cold water. 

2. Separate blunts and sharps; unclasp hinged 
instruments. 

3. Wash in warm soapy water; use brush and 
sand soap as needed for serrated parts. 

4. Dry carefully. Reassemble hinged instru- 
ments; oil hinges very lightly. 

5. Stow in cabinet. 

Points to remember 

1. Acids, bichloride of mercury, and chloride of 
lime corrode and stain steelware (CRM ware). 

2. Enamelware chips easily. 

3. Metalware dents easily when dropped or 
banged. 



Glassware 

General instructions 

1. Rinse with cold water. 

2. Wash with warm soapy water to which am- 
monia has been added (4 cc. to 1,000 cc. water). 

3. Inspect for chips and cracks. 

4. Stow in proper place. 

Tubing, connecting tips 

1. Soak in hydrogen peroxide if coated or 
blocked with organic residue. 

2. Use cotton applicators to clean inner surfaces. 

Syringes 

1. Separate barrel and plunger after rinsing 
with cold water. 

2. Soak in dilute hydrochloric acid for 20 min- 
utes if syringe is clouded or sticky. 

3. Use a small bottle brush or cotton applicator 
to clean the barrel. 

4. Match barrel and plunger according to num- 
ber etched on the sides. 

Points to remember 

1. Survey all chipped or cracked glassware. 

2. Never boil a syringe with plunger in barrel. 

3. Wrap glassware in gauze or muslin, when 
sterilizing by boiling, to prevent breakage. 
Rubber goods 

General instructions 

1. Wash with cool soapy water; rinse well with 
clear water ; dry thoroughly. 

2. Roll or hang in cool place. 
Tubing, catheters, rectal tubes 

1. Rinse under cold running water. 

2. Wash with cool soapy water ; rinse. 

3. Use cotton applicators if needed, to clean 
openings (eyes) of catheters and tubes. 

4. Wrap in gauze ; boil for 5 minutes. 

5. Dry, drain, stow in coils without kinks. 
Hot water bottles, ice bags 

1. Wash with warm soapy water; rinse with 
clear water ; dry ; drain. 

2. Inflate bag ; apply cap. 

3. Stow in cool place (preferably hanging up). 
Air rings 

1. Rinse with cold water; wash with warm 
soapy water; rinse with clear water; dry. 

2. Inflate ; powder lightly, and stow hanging up 
or flat in drawer. 



NURSING AND NURSING PROCEDURES 



293 



Gloves 

1. Rinse in cold water. 

2. Wash in warm soapy water: rinse; test for 
holes; dry; arrange in pairs. 

3. Send to central supply room. 







Figure 321. — Method of Inverting Rubber Gloves. 

Points to remember 

1. Oil, heat, soap, cresol, and sunlight deteri- 
orate rubber. 

2. Rubber goods must be dry when stored. 

3. Do not dry rubber goods over a radiator or 
store near hot pipes. 

4. Always roll rubber sheets; never fold them. 

5. Always remove clamps from tubing before 
boiling. 

Care of Linen 

A. Control the supply of linen 

Correct daily exchange 

Count each piece of linen. Record totals on 
laundry list in duplicate. Original goes with 
linen to laundry, copy kept in ward. 

Check linen from laundry against ward copy. 
Get I O U for any linen owed by linen room. 

Weekly inventory 

Follow instructions in station orders. 

Make actual count of all linen on ward. Record 
in "Charge on Hand Book." Check with laundry 
lists and 1 O U's of the past week for totals. 

211860°— 53 20 



Send charge book to senior muse corps officer 
who reports through official channels to the com- 
manding officer. 

Locked linen locker 

Keep kc\ g on person. 

Allow only Staff personnel access to linen locker. 

Require up patients to obtain clean linen on ex 
change hasis. Keep linen in orderly arrange- 
ment, shelves clearly marked, linen neatly stacked. 

B. Proper use of linen 

Insist upon linen being used as intended, pillow 
case for pillow, towel for bathing the patient. 
Cleaning cloths may be obtained from linen room 
by requesting them on laundry list. 

Torn linen : 

1. If soiled, place in hamper for laundry. 

2. If clean, fold with tear uppermost; put 
aside in linen locker. 

3. Send to linen room on specified day on an 
exchange basis. 

C. Protect linen 

1. Use rubber pillow cases and sheets when pa- 
tient is incontinent, vomiting, hemorrhaging, has 
discharge, or wet dressings. 

2. When stripping the bed, lift mattress with 
one hand and loosen bedding with other hand to 
avoid tearing sheets on bedsprings. 

3. Remove stains before sending linen to 
laundry. 

4. Obtain special linen from linen room for 
patients whose treatment causes staining of linen. 




Figure 322. — Protecting Linen. 

Removal of stains 

Remove as soon as possible. 

Use simplest method first. Stretch stained por- 
tion over sin! or basin, stained side down: pour 
cold water through stain. 



^4 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 323. — Removing Stains. 

Blood stains 

Fresh. — Same as above. 

Old. — Add ammonia to warm soapy water. 

On mattress. — Apply paste of talcum powder or 
starch; let dry; brush well. Repeat until stain 
disappears. 

Feces. — Same as in general. 

Medicine. — Pour cold water through stain ; use 
alcohol for tinctures. 

Ink. — Apply salt paste; soak in lemon juice. 
Dry in sunlight. 
Fruit. — Pour boiling water through stain. 

Care of Cleaning Gear 

Swabs 

1. Stow in swab racks outside the ward. 

2. Wash with hot soapy water twice weekly. 

Push brooms 

1. Stow in gear locker, brush head up. 

2. Use for dry sweeping or with compound. 

Dry mops 

1. Stow in gear locker, mop head up. 

2. Send mop head to laundry weekly. 

Cleaning cloths 

1. Wash with hot soapy water after use. 

2. Allow cloths to dry before placing them in 
the hamper. 

3. Obtain cleaning cloths from laundry. 

The Drug Supply of the Ward 

The ward should be stocked with enough drugs 
to last 24 hours or over a week end. Drugs should 
be stored in the medicine locker. Those drugs 



requiring refrigeration should be stored in the 
galley refrigerator. 

Care of the medicine locker 

1. Keep the medicine locker locked. The key 
should be carried by the corpsman in charge of 
medications. 

2. Store narcotics in a separate locked cabinet 
within the medicine locker. The key must be car- 
ried by the nurse officer in charge of the ward. 

3. Arrange drugs within the locker in an or- 
derly manner. Be sure all labels are plainly 
visible. Suggested arrangement : 

Upper section : 

Top shelf — liquids for internal use. 

Middle shelf. — Capsules, pills, powders; 
grouped according to their use. 

Lower shelf. — Drugs to be used externally, 
such as eye drops, nose drops, ointments. Nar- 
cotic locker containing all narcotics, barbitu- 
rates, mixtures containing opiates. 
Lower section : 
Left side : 

Top drawer. — Drugs to be given by injection 
and emergency stimulants. 

Second drawer. — Sterile autoclaved syringes 
and needles, tourniquets, and covered container 
of alcohol sponges. 
Right side : 

Cabinet. 

First shelf. — Oral medicine tray. 

Bottom shelf. — Poisons in poison bottles with 
poison labels. 

4. Post a list of symbols, abbreviations, and 
equivalents on the inside of the medicine locker 
door. 

5. Cleaning the locker : 

Wipe shelves daily when checking supply. 

Start at the top : remove only a few bottles at 
a time. 

Clean entire locker inside and out weekly. 

Caution. — If interrupted, be sure to return 
all drugs and lock locker before leaving. 

6. Drugs requiring refrigeration are stored in 
one section of the refrigerator. They are — 

Saline cathartics, oils, suppositories. 
Sera, vaccines, antibiotics, and biologicals. 

Maintain drug supply. — When ordering drugs: 

1. Check drug supply in locker and refrigerator 
each morning before sick call. 



NURSING AND NURSING PROCEDURES 



295 



•2. Make out order in drug book. Use intelli- 
gence in ordering; order according to the rate of 

use. The amount of drug you order will depend 
upon how often it is given, the size of the dose, 
and the number of patients receiving it. 

3. General rule to follow when ordering drugs: 

If item Is used in dosages 

of — Order in quantities of — 

Drop or minim 10-30 cc. 

4-16 cc 100-250 cc. 

10-30 cc. 500-1.000CC. 

30-100 cc. or over 1,000-4.00(1 cc. 

1-2 tablets or pills no khi tablets or pills. 



I. Return to pharmacy — 

All drugs in poorly labeled or unmarked l>"t 
ties or boxes. 

A II drugs not in current use. 

All drugs showing a change in color, odor, or 
consistency. 

5. Make out prescription blank- for alcohol. 
narcotics, and other drugs a- required by station 
orders. 

6. Present drug hook and prescriptions lor doc- 
tor's signature at Sick Call. 

7. Send drug basket, drug hook, and prescrip- 
tions to the pharmacy by 0980. 



SUGGESTED ADDITIONAL READING— UNIT V 

Young, Helen; Lee, Eleanor, and Associates. 



Barrett, Jean, Ward Management and Teaching. 

New York: Appleton-Century-Croft Inc., 1949. 



Essentials of Nursing. 2d ed. res. New York 
G. P. Putnam's Sons. L948. Pp. 503-515. 



INTRODUCTION TO THE OPERATING ROOM AND CENTRAL SUPPLY— UNIT VI 

The methods and procedures outlined are those 



The purposes of this section are to acquaint the 
general service corpsman with: 

1. The preparation and sterilization of surgical 
supplies and equipment. 

2. The preparation of the operating room for 
general surgery. 



of several stations and therefore are general rather 
than specific practices. The corpsman i- advised 
to refer to the local station orders for routines per- 
taining to his particular situation. 



PREPARATION OF SUPPLIES AND EQUIPMENT 

Review — Chapter III, "Inflammation" 

"Wounds" 

Unit III, "Surgical Dressings" 



SURGICAL ASEPTIC TECHNIQUE 

Methods developed in the care of the patient 
with an open area which will protect him from 
possible infection carried in the air. by the worker 
and his equipment, or by other patients are termed 
surgical aseptic or "sterile" techniques. 

Any measure used to prevent the spread of in- 
fection for any patient is part of surgical aseptic 
technique. Full surgical aseptic technique is prac- 
ticed in the operating room. Modifications or ad- 
aptations of these techniques are carried out on 
the wards when doing dressings or treatments, 
such as, injections, instillations, irrigations, or re- 
moval of body fluids. 



Principles of Surgical Aseptic Technique 

1. All articles used in direct contact or indirect 
contact with a wound must be sterile. 

2. The best available method of sterilization 
must he used in preparing supplies. 

:'). A sterile article must he labeled with the date 
of sterilization. 

4. Articles not used within 7 days of the date 
of sterilization must he opened, inspected, re- 
wrapped and resterilized. 

5. The transfer of organisms from the clothing 
of personnel to sterile areas must he prevented. 

6. The skin of the patient and of the personnel 
must be made as clean as possible. 



?96 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



7. Contamination of sterile areas or supplies by 
airborne organisms must be prevented. 

The use of mechanical agents to carry out these 
principles are : caps, masks, gowns, gloves and in- 
struments and handwashing. 

For other applications of the principles of 
surgical aseptic techniques see : 

Surgical Dressings, pp. 251-256. 

Preoperative Skin Preparation, pp. 274-277. 

DISINFECTION AND STERILIZATION 

Purpose: Disinfection — to destroy pathogenic- 
organisms ; sterilization — to destroy all organ- 
isms. 

Cleaning. — All articles must be thoroughly 
cleaned before any disinfection or sterilization is 
attempted. The washing and scrubbing with soap, 
water and a mild abrasive mechanically remove 
many bacteria. All cleaned articles must be rinsed 
in clear water to remove the cleansing agents. 

Methods of disinfection and sterilization 

The selection of a method for disinfecting or 
sterilizing an article depends upon : 

1. The composition of the article (metal, glass, 
rubber, plastic, tissue). 

2. The nature of the organism to be destroyed. 

3. The time required to destroy the organism. 

4. The nature of the disinfecting agent. 

5. Cost. 

Physical agents used in sterilization 

The physical agents vised are moist or dry heat. 

Important points to remember when using these 
agents are the temperature required, the time re- 
quired, and contact by heat with all parts of the 
article being sterilized. 

Boiling water (utensil and instrument ster- 
ilizers) 

1. Used for metalware, glassware, some rubber 
goods. Do not use for plastics or hard rubber 
articles. 

2. The article to be boiled must be completely 
covered by water. Wrap rubber goods in gauze 
or old linen to keep them submerged during boiling 
period. 

3. Allow enough room in the sterilizer for all 
art icles to be in contact with the boiling water. 




^^^^"^BBB 



Figure 324. — Utensil Sterilizer. 

4. Time : 10 minutes for small articles (syringes. 
rubber tubing) ; 20 minutes for large articles- 
(basins, pitchers). 

The boiling period is timed from the start of 
vigorous boiling. When this period is reached, 
reduce steam sufficiently to maintain boiling point 
without wasting steam. 

Steam under pressure (autoclave) 

1. Method of choice for metalware, glassware, 
rubber tubing, gloves, and dry goods. 

2. The articles must be wrapped or placed in a 
container before sterilization. 

3. Each article must be labeled with date of 
sterilization. 

4. Articles to be autoclaved should be as nearly 
the same size and type as possible. 

5. Allow enough space in the autoclave for all 
articles to be in contact with the steam. As each 
item is placed in the autoclave, imagine it to be 
filled with water. Place the item so that the water 
will drain out. 

6. Use sterilizer controls (ATI or Diack con- 
trol) in each load autoclaved. 

7. Operating the autoclave. 
Turn on steam valve. 
Load autoclave. 



NURSING AND NURSING PROCEDURES 



297 



Chamber gauge-.__ 



Operating valve' 



Jacket gauge 



Safety valve 




!--Thermometer 

il 

(^--Pressure regulofor 



--Steom safety volve 
Figure 325. — Diagram of Autoclave. 

Close door tightly when pressure in jacket 
reaches 17 pounds. 

Turn operating valve to "sterilize." 

Start timing sterilization period when cham- 
ber gauge registers 17 pounds pressure and ther- 
mometer registers 250° F. 

Follow "8" below for sterilization period. 

Turn operating valve to ''exhaust" when time 
for sterilization is finished. (See par. 8.) 

Turn operating valve to "vacuum" when 
chamber gauge reads "zero." 

Allow to remain on "vacuum" 5 to 10 min- 
utes, according to size of package being auto- 
claved. 

Turn operating valve to "off." 

Open door when gauge reads "zero." 

Allow door to stand open 1 inch for 15 min- 
utes. 

Unload autoclave. 

Check sterilizer controls. (Turn off steam 
supply if no further autoclaving is to be done.) 
8. Time (250° F. at 17 pounds pressure) : 

Dry goods (large packs), 45 minutes. 

Dry goods (average packs) 30 minutes. 

Unwrapped instruments or Small instrument 
trays, 10 minutes. 

Wrapped instruments or instrument trays, 30 
minutes. 

Wrapped rubber gloves, 15 minutes. 



Flasks of solution two-thirds full: 1,000 <•<■.. 
15 minutes; 2,000 cc, 20 minutes. 
Dry heat (hot air oven) 

1. Used for ointments, oils, waxes and powders ; 
may also be used for glassware, instruments, 
needles, dry goods. 

2. Time — for oils, ointments, waxes, powders: 
120 minutes at 320° F. ; for glassware instruments, 
needles, dry goods: 60 minutes at 320 F. 

Flame (incineration) : 

1. Used for materials which can be burned — 
food, paper materials, dressings. 

2. Time — until completely destroyed. 

Sunlight 

1. Used for clothing, bedding, and mattresses. 

2. Time — 6 hours or more in direct sunlight — on 
each side. 

Chemical agents used in sterilization 

Chemical disinfection or sterilization is used 
only when an article cannot withstand other 
measures of sterilization. There is no chemical 
disinfectant available which meets requirements 
for destroying all organisms on all articles. Es- 
sential factors are strength of solution required, 
time required, and contact by chemical with all 
parts of the article being sterilized or disinfected. 

1. Quaternary ammonium compounds have been 
found to be effective in high dilutions and more 
effective in the presence of organic matter than 
man}' other disinfectants. However, they are not 
effective in the presence of soap or against the 
tubercle bacillus. 

Used as a skin disinfectant in 1 : 1000-1 : ."•< lll(l 
dilutions. 

Used as sterilizing agent for sharp and deli- 
cate electrical instruments. The quaternary 
ammonium compound most frequently used is: 
Benzalkonium chloride, 30 cc.; sodium nitrite, 
30 cc. (Antirust agent.) Distilled water, qs, 
4,000 cc. 

Time: 30 minutes for vegetative bacteria; 18 
. hours for spore forming bacteria. 

2. (Jrcxol compownd. — Saponated cresol com- 
pounds cause i issue damage when used in strengths 
greater than one-half of 1 percent. Their primary 



98 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



value lies in disinfection rather than in sterili- 
zation. 

Used in a 4 percent solution to disinfect body 
excreta when precautions must be taken before 
disposal. May also be used for soaking bed 
linen when precautions must be taken before 
sending it to be laundered. 
Time : 60 minutes. 

3. Alcohol. — Alcohol is valuable for maintain- 
ing sterility after an article has been sterilized by 
other methods. Alcohol cannot be used for in- 
struments that have plastic or cemented parts and 
it is not effective against spore- forming organisms. 

Used in 70 percent solution as a skin disinfect- 
ant prior to the administering of injections or 
infusions; as a disinfectant solution for ther- 
mometers; to maintain sterility of syringes and 
instruments after they have been sterilized by 
other methods. 

4. Mercurials. — The mercurials are effective 
against many organisms but they corrode metals 
and coagulate protein material such as sputum 
which provides protection for organisms. 

Oxycyanide or mercury 1 : 1000 is sometimes 
used to sterilize the hermetically sealed glass 
tube of suture materials. 

Time : 18 hours. 

Preventing Contamination 

To maintain sterility after an article is steri- 
lized it must be protected from contact with un- 
sterile areas. 

1. Articles sterilized by boiling: 

Use sterile forceps to remove article from 
sterilizer. 

Immediately place the article in a sterile, cov- 
ered container or wrap in a double thickness, 
sterile towel. Use care to avoid dripping water 
on the towel; if towel becomes wet, it is no 
longer sterile and the process must be repeated. 

2. Articles sterilized by autoclaving. 

Article is prepared and sterilized in the con- 
tainer or wrapper in which it can be stored. 

Close the cover of metal containers before re- 
moving article from autoclave. 

Be sure article is dry before removing from 
autoclave. 

3. Articles sterilized by chemicals : Follow same 
procedure as "1. Articles sterilized by boiling." 



PREPARATION OF SURGICAL SUPPLIES FOR 
AUTOCLAVING 

General rules 

1. All articles to be sterilized must be clean and 
in good condition. 

2. Articles to be autoclaved must be wrapped in 
heavy paper, double muslin covers, or placed in 
metal or glass containers. 

3. Packages and containers must be labeled. 

4. Packages and containers must be dated after 
autoclaving. 

Linen (masks, gowns, sheets, towels) 

1. Inspect all linen for holes, tears, weak spots. 

2. Roll masks singly and pack loosely in metal 
containers or paper bags. 

3. Fold gowns lengthwise, wrong side out, roll 
from hem to neckband. Wrap singly in paper 
or double muslin covers. 

4. Fan fold sheets and towels so that edges are 
on the outside. Wrap singly in paper or double 
muslin covers. 

5. Time — 250° F. at 17 pounds pressure. 

a. Large packages or containers — 45 minutes. 

b. Average packages or containers — 30 min- 
utes. 

Dressings 

1. Compresses, applicators, cotton balls — pack 
loosely in metal containers or wrap in paper or 
double muslin covers. 

2. Pads — fold pad in half, smooth side inside, 
and wrap singly in paper or double muslin covers. 

3. Vaseline gauze strips. 

Cut 2- or 3-inch gauze bandage into strips to 
fit the tray. 

Alternate strips of gauze with melted vaseline 
until tray is filledto within % inch from the top. 

4. Time — same as for linens. 

Note. — Sterilization of vaseline gauze by hot air oven 
is recommended where available. Time: 120 minutes at 
320° F. 

Glassware (syringes, tubing, beakers, tips, jars) 

1. Inspect all glassware for cracks or chips. 

2. Wash with soap or detergent and water; rinse 
well. 

3. Clean inner surfaces with applicators. 



NURSING AND NURSING PROCEDURES 



299 



PREPARATION OF SURGICAL SUPPLIES 



* X 4'* 
cut gouze 16" % 16" 



2 x 2's 

CVt gauze 

8"* a" 



TO MAKE GAUZE FOLDED 



For 4 x 4's fold to 8"x 16" 
For 2 x 2's fold to 4"x 8*' ■ 



-rfold to 8"x8" 
— ► fold to 4"x4" 



-♦•4 x 8 
-»2"x2" 



-»4"x4" 
-»2"x2" 



TO MAKE ABDOMINAL PADS 





Gauze 16" x 16" 
Cellucotton 8"x 8" 



Turn in narrow edge 
of gauze olong left side 



Fold upper and lower 
gauze flaps to center 
of cotton 



Fold right side of 
gauze to center 
of cotton 



Fold left side Fold pad in 
of gauze to half smooth 

center of cotton side inside 



TO WRAP DRY GOODS 




Place article to be wrapped on 
o double muslin or heavy paper 



Bring corner (I) up over 
article fold back flop 



Bring corner (2) up 
over article fold 
back flop 



Bring corner 
(3) up over 
article fold 
bock flop 



Bring corner 
(4) up over 
(3) and tuck 
under (2) 
ond (3) 



TO MAKE COTTON APPLICATORS 





Place several applicator 
sticks in o small con- 
tainer of water 



Take opplicator stick. Pick 
up small amount of cotton 
by rotating stick 



Smooth cotton over end 
of stick, be sure tip 
is covered 



Wind cotton around stick 



Q 



TO MAKE COTTON BALLS 





Take circular piece of cotton 



Place piece of cotton in circle 
formed by index finger ond thumb 
press in center of cotton 



Moisten tips of index and 
middle finger, twist top of 
cotton together between 
fingers 



ure 326. — Preparation of Surgical Supplies. 







HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 





Figure 327. — Wrapping Syringes. 

4. Syringes. 

Match numbers on plunger and barrel. 
Wrap plunger and barrel in gauze, separate 
surfaces by layer of gauze. 

Wrap in paper or double muslin cover. 

5. Tubing, beakers, tips. 

Wrap in gauze, then in paper or double muslin 
covers. 

When part of a sterile tray, always wrap in 
gauze. 

6. Jars : No wrapping necessary ; prepare same 
as regular glassware. 

7. Time : Same as for linens. 

Metal containers (cans, jars, trays) 

1. Remove cover from container. 

2. Place and tie a gauze cover over container. 

3. Replace metal cover loosely on top of 
container. 

4. Turn container on side in the autoclave to 
allow penetration by steam. 

5. Time : Same as for linens. 

Instruments 

1. Wash instruments with warm soapy water; 
brush the hinged or serrated parts ; rinse and dry. 

2. Instrument trays. 

Place a single thickness of linen in bottom of 
tray. 

Open all hinged instruments. 

Fill tray to within one-half inch of top by 
alternating a layer of instruments with a layer 
of linen. 

3. In treatment trays, open hinged instruments. 

4. Time: 30 minutes at 250° F. at 17 pounds 
pressure. 



Needles (for injection, suture) 

1. Inspect all needles for hooks and burrs. 

2. Needles for injection. 
Rinse with cold water. 

Clean hub of needle with cotton applicator. 

Pass a stilet through bore of needle. 

Rinse needle with alcohol, ether. Dry with 
needle drier. 

Insert a small piece of cotton in bottom of a 
glass tube ; place the needle in the tube and plug 
the tube with cotton. 

3. Suture needles. 

Wash and dry needles. Scour with Bon Ami 
when necessary. Always clean toward point of 
needle. 

Arrange needles according to type on a piece 
of gauze (straight, curved, round or cutting 
edge, tapered point). 

Time : Same as for instruments. 

Rubber goods (gloves, tubing, drains) 

1. Gloves. 

Inflate gloves. Test for holes. 

Lightly powder gloves inside and out. 

Sort into pairs ; turn back a 3-inch cuff. 

Place gloves inside muslin or paper glove 
holder. Add packet of powder. 

Wrap package in a paper or double muslin 
cover. 

Write glove size on the outside wrapper. 

2. Tubing. 
Remove all clamps. 

Wash tubing with warm soapy water; rinse. 







l*\ .' • »*« 

• ' i'' 1 

• • i * > 

: •: i J : 
i > • .' • 
Si ' . ; 

i / » • 
i / i ; 

V •' i 

1 1 
1 1 
1 1 
> 1 
1 1 
1 1 
I 1 
1 • 




I . • • • I 

i '■ K ' i 

I \ » • 

I > X 1 

1 ■ 1 
.' J. 




\ r 

• i 

• i 
i i 
> i 






POWDER 













Figure 328. — Glove Wrapping. 



NURSING AND NURSING PROCEDURES 



301 



Place flat in a container or wrapper or coil 
loosely without kinks in treatment trays. 
-">. Drains. 

Rubber dam. 

(1) Wash thoroughly in warm soapy 
water; rinse. 

(2) Cut into lengths and widths as needed. 

(3) Place Hat in a metal container or sus- 
pend in a glass tube. 

Cigarette drains: 

(1) Wash thoroughly with warm soapy 
water; rinse. 

(2) Insert gauze bandage through center 
of tubing. 

(3) Place flat in a metal container or sus- 
pend in a glass tube. 

Catheters : 

(1) Wash thoroughly with warm soapy 
water; rinse. 

(2) Place on covered wooden splints and 
wrap in double muslin or paper covers or 
place flat in metal container. 

4. Time: 15 minutes at 250° F. at 17 pounds 
pressure. 

Suture materials (catgut, silk, cotton linen, 
wire, horsehair, clips) 

1. Silk, cotton, horsehair, nylon, linen. 
Wrap material loosely about a piece of card- 
board or cut into strands. 

Place in a test tube and wrap in a double mus- 
lin cover; place in treatment or instrument tray. 

2. Clips, treat same as above. 

3. Time: Same as for instruments. 

4. Suture material in hermetically sealed tubes. 
Boilable — autoclave with treatment or instru- 
ment trays. 

Nonboilable. 

( 1 ) Wash tube with soap and water : rinse. 

(2) Place in a covered container of mer- 
curic oxycyanide 1: 1000 for 18 hours. 

(3) Store in a covered container of alcohol 
7() percent (Bethesda NNMC). 

SELECTED STERILE TRAYS 

These trays are equipped and stocked by the 
central supply room (CSR) or the central dressing 
room (CDR) in most naval hospitals. 
Aspirating tray 

One 3 cc. local set. 

One 30-cc syringe with metal adaptors. 




Two cultur 
One No. 13 
One No. 15 
One No. 16 
One No. 16 
One No. 17 
One No. 18 
One No. 19 
One No. 20 
One No. 20 
Six 4 x 4's. 
Two drape 
One towel. 



Figure 329. — Aspirating Tray. 

e tubes. 

gage 2-inch needle. 
gage 2-inch needle, 
gage 1-inch needle, 
gage 2-inch needle, 
gage 314-inch needle, 
gage 2-inch needle. 
gage 2-inch needle, 
gage 3- inch needle, 
gage 2-inch needle. 

sheets. 



Dressing tray 

One surgical scissors. 
One hemostat. 
One thumb forcep. 
Two applicators. 
Four 4 x 4's. 
One towel. 




Figure 330. — Dressing Tray. 



3 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 331. — Biopsy Tray. 

Biopsy tray 

One 10 cc. Luer Lok syringe. 

Two 22 gage 3-inch local needles. 

Two 26 gage hypodermic needles. 

One No. 3 knife handle. 

One No. 11 blade. 

Two tubes plain catgut. 

Two liver biopsy needles. 

One needle holder. 

Three lengths 3-inch roller gauze. 

One beaker. 

Six 4 x 4"s. 

Six swabs. 

Two field sheets. 

Catheterization tray 

One emesis basin. 

Two beakers. 

Two catheters No. 14, No. 16. 




Six cotton sponges. 
One specimen bottle. 
One sheet. 
Two 4 x 4's. 
One tube of water 
shown) 



soluble lubricant. (Not 




Figure 333. — G. U. Set. 

G. U. set 

One emesis basin. 
One asepto syringe. 
One medicine glass. 
Two 4 x 4's. 

Emergency suture tray 

One knife handle No. 3. 
One needle holder. 
Two mosquito hemostats. 
Two straight hemostats. 
Two curved hemostats. 
Two Allis clamps. 
One tissue forceps. 




Figure 332. — Catheterization Tray. 



Figure 334. — Emergency Suture Tray. 



NURSING AND NURSING PROCEDURES 



303 



One rat tooth forceps. 

( )iu> suture scissors. 

One 3 cc. syringe with local set. 

Three knife blades, Nos. L0, 1 1, 15. 

Two towel clips. 

One set suture needles. 

Two black silk, No. 00, No. 000. 

Two field sheets. 

One drape sheet. 

Four 4 x 4's. 

Local set 

One medicine glass. 
One 3 cc. Luer Lok syringe. 
One No. 22 gage l^-inch needle. 
One No. 23 gage %-inch needle. 




Figure 335. — Local Set. 



Lumbar puncture tray 

One 10-cc. syringe. 
One 20-cc. syringe. 
One 2-cc. local set. 




1 I 



Figure 336. — Lumbar Puncture Tray. 



One No. 18 gage spinal needle. 
One No. "20 gage spinal needle. 
Three specimen tubes with corks. 
( me drape sheet and towel. 

Two applicators. 

Four 1 x 4's. 

One manometer. ( Not shown ) 

Paracentesis tray 

One 2-cc. syringe. 
One No. 22 gage 1 ' g-inch needle. 
One No. 22 gage 2-inch needle. 
One No. -2-\ gage :! r inch needle. 
One 30-cc. syringe. 
One medicine glass. 

One piece rubber tubing, ■> feel in length with 
glass connection. 

One cannula, straight. 




Figure 337. — Paracentesis Tray. 

One two-hole rubber stopper with 4-inch 
straight glass rod. 

One knife handle No. 2. 

Two blades, No. 10, No. 11. 

One set assorted suture needles. 

One drape sheet. 

Two field sheets. 

Sixteen 4 x 4's. 

One long piece rubber tubing. 

One black silk, No. 0, No. 00, No. 000. 

Two mosquito forceps. 

One 8-way stopcock. 

One right-angle glass tube. 

Phlebotomy tray 
One plain forceps. 
One rat tooth forceps. 



?.j4 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 




Figure 338. — Phlebotomy Tray. 

Two mosquito hemostats, straight. 

Two mosquito hemostats, curved. 

Oue knife handle No. 3. 

One straight scissors. 

One needle holder. 

One set knife blades, No. 10, No. 11. 

One No. 18 gage needle. 

One No. 20 gage needle. 

One No. 15 gage needle. 

One No. 18 and 1 No. 20 titus needle. 

One medicine glass. 

One 2-cc. syringe. 

One set suture needles. 

One set local needles. 

One adaptor with rubber tubing. 

One drape sheet. 

One black silk No. 0, No. 00, No. 000. 

Five 4 x 4's. 

One tube No. plain suture. 

One tube 3-0; 4-0; 5-0 dermal suture. 

Sternal marrow puncture set 

One 2 cc. local set. 

Two 2-cc. syringes. 

One 10-cc. syringe. 

Two curved mosquito hemostats. 

One No. 3 knife handle. 

One No. 11 blade. 

Two sternal puncture needles. 

Four 4 x 4's. 

Two applicators. 

Two right-angle tubes. 

One field sheet. 




Figure 339. — Sternal Marrow Puncture Set. 

Pneumothorax tray 

Two towels. 

Two No. 17 gage, 3-inch needles. 
Three No. 18 gage, 2-inch needles. 
Three No. 21 gage, 2-inch needles. 
One 10-cc. syringe. 
One 2-cc. syringe. 
One No. 26 gage needle. 

One black rubber tubing with needle adaptor 
and glass connection. 
One medicine glass. 
Two needle adaptors. 
One 30-cc. syringe. 
Aspirating needles. 
Local needles. 




Figure 340. — Pneumothorax Tray. 

Venous pressure tray 

One spinal manometer and stopcock. (Steril- 
ize separately) 

One 20-cc. syringe with No. 20 gage needles. 
One T. B. syringe with No. 23 gage needles. 



NURSING AND NURSING PROCEDURES 



305 




Figure 341. — Venous Pressure Tray. 

One 10-cc. Luer Lok syringe with finger control. 
Four 4 x 4's. 

Thoracentesis tray 

One medicine glass. 

One 2-cc. syringe with No. 23, No. 20 g:ige 
needles. 

One 30-cc. syringe with adaptor. 

One Pilling guard. 

One rubber tubing with needle adaptor. 

Two No. 20 gage 2-inch needles. 

One No. 18 gage 3-inch needle. 

One No. 21 gage needle. 

Two drape sheets. 

One drape sheet. 

One emesis basin. (Not shown) 




J 




Figure 343. — Wet Dressing Tray. 

Wet dressing tray 

One asepto syringe. 

One basin. 

One thumb forceps. 

One emesis basin. (Not shown) 

Tracheotomy set 

One Jackson aspirating tube. 
Two small, medium, large silver tracheotomy 
tubes with tapes. 

Two tracheotomy retractors. 

Six curved hemostats. 

One trachea] dilator. 

One tracheal blunt bistoury. 

One dissecting scissors, straight. 

One thymus retractor. 

One tracheal tenaculum. 

One needle holder. 

Four towel clips. 




Figure 342. — Thoracentesis Tray. 



Figure 344. — Tracheotomy Set. 



,6 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



One 3-cc. syringe. 

One No. 22 gage li/o-inch needle. 

One No. 22 <ra<re 2-inch needle. 

One No. 23 gage %-inch needle. 

Eight 4 x 4's. 

Three drape sheets or towels. 



Two assorted No. 0, No. 00, No. 0000, No. 00000 
plain catgut. 

One rat tooth forceps. 
One plain forceps. 
Two applicators, wooden. 
One set suture needles. 



PREPARATION OF THE OPERATING ROOM 
Review Local Station Orders 



The procedures outlined in these pages are those 
necessary to prepare the patient, personnel, and 
equipment for general surgery. The additional 
instruments and equipment required by the sur- 
geon for a particular operation should be ascer- 
tained by the operating room corpsmen before 
preparations are begun. 

The operating room 

Cleaning. — Daily routine cleaning should con- 
sist of swabbing the floors and damp dusting all 
furniture. Each week the walls, floors, and fur- 
niture should be vigorously scrubbed with soap 
and water. 

Lighting. — Overhead lights used to provide con- 
centrated shadowless light during the operation 
should be checked each day. 

Ventilation. — The temperature of the operating 
room should be constant, preferably 70° to 74° F. 
with humidity of 48 to 55 percent. 

Furniture 

Operating table. 
Gown and drape table. 

Double ring stand with tray secured over one 
ring. 

Single ring stand. 

Two instrument tables (Mayo stand). 

Anesthetist's table. 

Anesthetist's stool. 

Equipment for general surgery 
General laparotomy pack 

Two Mayo stand covers. 

Four packs 4x4 gauze (12 per pack). 

Two upper sheets. 

One single fold sheet. 

One laparotomy sheet. 

Fifteen towels. 



Five 10 x 10 sponges. 

Five 2 x 10 sponges. 

Three gowns. 

One special bag containing one ABD pad, one 
roll hernia tape, eight safety pins, three cotton 
swabs. 

General instrument tray 

Two No. 3 knife handles. 

Two plain thumb forceps. 

Two rat tooth thumb forceps. 

One Russian dressing forceps. 

Two needle holders. 

One suture scissors. 

One curved Mayo scissors. 

One straight Mayo scissors. 

One Metzenbaum scissors. 

One probe. 

One groove director. 

Two Michel clip holders and clips. 

One ribbon retractor. 

One pair Parker retractors. 

One pair Richardson retractors. 

One pair medium Deaver retractors. 

Twelve small curved Kelly hemostats. 

Twelve small straight Kelly hemostats. 

Six Allis clamps. 

Six Kocher clamps. 

Three Babcock intestinal clamps (two small, 
one large). 

Twelve towel clips. 

Twelve sponge forceps. 

One needle book. 

One pair Army retractors. 

The laparotomy pack and instrument tray are 
wrapped, autoclaved and kept in readiness for im- 
mediate use at all times. 



NURSING AND NURSING PROCEDURES 



307 



The operating room personnel 

The surgeon, his assistants, the anesthetist, the 
operating room nurse and corpsmen change their 

uniforms for operating room clothes. 

Duties of the circulating corpsman 
Before the operation 

1. Damp dust all furniture in the operating and 
scrub rooms. 

2. Set up scrub room. 

3. Set up operating room; bring all necessary 
supplies, set furniture in proper places, adjust 
lights, check working order of all electrical units. 

!. Assist send) corpsman in donning gown and 
gloves. Open laparotomy pack for scrub corps- 
man. 

5. Preparation of the patient: 

Place patient on table in the proper position. 

(1) For general anesthesia, place restraint 
over patient's knees, secure his arms at the 
sides. 

(2) Spinal anesthesia. Place patient on 
his side, with knees flexed and head drawn on 
his chest until after anesthesia has been given. 
Remain with the patient and anesthetist dur- 
ing the administration of the anesthetic. 

6. Remove all sponges used for the anesthesia 
and preparation of the skin from the room before 
the case begins. 

During the operation 

1. Remain in the room at all times. 

2. Anticipate the needs of the '"scrubbed" corps- 
man and surgeon. 

3. Keep sponge count. Before the peritoneum is 
closed, check with scrub corpsman. The number 
of used sponges, the number the scrub corpsman 
still has must equal the total number of sponges 
placed in the operating room. If the count is 
not correct, the surgeon must be told and search 
instituted for the missing sponges. 

After the operation 

1. Assist in applying the outer dressing. 

2. Bring stretcher into room and assist in lifting 
the patient from the table. 

3. Cover the patient and send him with a corps- 
man to his ward. 



Duties of scrub corpsman 

1. Scrub, don gown and gloves. 

2. Drape each table and stand with COVer, held 
cloth, and towels. 

3. Place basins in ring stands. 

4. Arrange instrument table and ring stand. 

5. Prepare spinal tray if spinal anesthesia is 
to be given. 

6. 1'repare sponge si icks for paint ing I lie opera- 
tive site. 

7. Assist with draping the patient. 

a. Four towels placed to expose operative site; 
secured by clips. 

b. Sheet over upper part of patient and screen. 

c. Sheet over lower part of patienl . 

d. Laparotomy sheet over the entire patient 
with the opening directly over the operative site. 

e. Two towels secured by towel clips directly 
over site so that only operative area is exposed. 

8. Move the instrument table up into place. 

9. Prepare sutures. 

10. Anticipate the surgeon's and his assistant's 
needs. 

11. Keep sponge count. Check with circulating 
corpsman before the closing of the peritoneum. 

Preparation of the scrub corpsman 

Cap and mask. — Cap and mask are clean rather 
than sterile and are donned before scrubbing hands 
or putting on sterile gown and gloves. The cap 
must completely cover the hair and mask cover the 
nose and mouth. 

Hand Washing Technique 

Methods 

1. Using running water and detergent: 
Preliminary wash: 1 minute — wash hands and 

arms to 2 inches above elbows. Clean nails with 

nail stick. Rinse by holding hands up. allow water 

to drain off elbows. 

Systematically scrub hands and arms with a 
sterile brush and detergent. 

(1) Begin at outer surface of the thumb; 
proceed to the inner, then to each linger: scrub 
the palm of the hand, then the back of the 
hand. Repeat for the other hand. 

(2) Scrub in a circular motion toward the 
elbows. 



308 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



3^^ 




I. Oon cap and mask. Scrub hands and arms. 
Receive gown . 



2. Touching only the inside of the gown, open 
gown ond slip arms into sleeves. 




3. Touching only the inside of the gown, assist- 
ant fits ond ties gown at neck and back. 



4. Touching only the ends of the belt, assist- 
ant brings and ties them at the back. 




Receive powder, open packet 
and powder hands. 




4. Slip gloved hand under cuff, 
draw glove on other hand. 



2. Receive glove ot edge 
of cuff. 



5. Roll glove cuff up 
over gown. 




3. Touching only the cuff, draw 
glove on one hand, anchor 
cuff over thumb. 




6. Slip hand under glove cuff of 
first hand, roll cuff up over gown. 



Figure 345. — Donning Gown and Gloves. Surgical Aseptic Technique. 



NURSING AND NURSING PROCEDURES 



309 




Figure 347. — BACK TABLE. Left to right. Front row: Gloves, 
powder for gloves, 3 sponge sticks, 4 skin towel clips, 4 sponge 
sticks with sponges for preparing field of operation. Back row: 
Three gowns, 8 towels, 3 sheets (1 laparotomy), sutures, skin 
preparation tray. This table is covered and pushed out of the way 
after the personnel are gowned and patient is prepared and 
draped. 




Figure 348. — RING STAND. Left to right. Front row: Five 
10x10 sponges, needle book, 2 needle holders, 1 Russian dressing 
forceps, 2 Michel clip holders and clips, 1 groove director, 1 probe, 
1 ribbon retractor. 




Figure 346. — THE OPERATING ROOM. Front row: Circulating 
nurse, assistant, anesthetist. Back row: Scrub corpsman, surgeon. 





Figure 350. — SPINAL ANESTHESIA TRAY. Left to right. Front 
row: Twenty cc. syringe, 2 cc. syringe, hemostat. Back row: 
Medicine glass with sterile saline, procaine, introducer, 2 spinal 
needles, 2 21 gage needles, 2 26 gage needles, 4x4 gauze. 



Figure 349. — MAYO STAND. Left to right. Front row: Twelve 
small curved Kelly hemostats, 12 small straight Kellys, 2 rat-tooth 
forceps, 2 plain forceps, Metzenbaum scissors, straight Mayor 
scissors, curved Mayo scissors, 2 scalpels. Center row: Suture 
scissors, package 4x4 gauze, 2 tubes ligature ties. Back row: 
One large Babcock, 2 small Babcock intestinal forceps, 4 Allis 
forceps, 6 Kocher and 8 large Kelly hemostats. 



Figures 346—350. — An appendectomy in progress. Note the placement of equipment and the positions of the personnel. 
211S66 — 53 21 



310 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Scrub 4 minutes, rinse by holding hands up; 
allow water to drain off elbows. 

Dry hands and arms with a sterile towel. 
Hold hands up ! 
2. Using running water and green soap: 

Wash hands and clean finger nails with a nail 
stick. 

Scrub hands and arms systematically with a 
sterile brush and tincture of green soap for 5 
minutes as described above. 

Discard first brush — with a new one. scrub for 
5 minutes more. 

Einse and reapply soap frequently during 
scrub period. 

After 10 minutes (total) rub alcohol into arms 
and hands. 

Dry hands and arms with sterile towel. Hold 
hands up ! 

Gown Technique 
Method 

1. Discard gown method is used. 

2. Gown is used once, removed and sent to the 
laundry. 

Summary of preparation for operation 28 

1. The operating room personnel are notified as 
to the time and nature of the operation. 

2. The hospital corpsman in charge of instru- 
ments selects those needed and puts them in the 
sterilizer along with the necessary utensils. 

3. The cutting instruments are placed in hot 
water sterilizer or in a sterilizing solution. 

4. All hands assist in placing the furniture and 
equipment in proper order. 



28 Adapted from Hospital Corps Handbook, 1939 edition. 



5. The circulating corpsman selects the packages 
of sterile goods and places them on the proper 
tables. 

6. The scrub corpsmen proceed to scrub up and 
don sterile gowns and gloves. 

7. The scrub corpsmen drape the tables and 
stands. 

8. The trays of sterile instruments are brought 
in and arranged in proper order on the instrument 
table. They are then covered with sterile towels 
until needed. 

9. The basin and utensil set is opened and 
placed in proper places. 

10. Additional sterile packages are opened and 
put in proper places. 

11. Sutures and ligatures are prepared. 

12. If spinal anesthesia is to be given, tray is 
prepared by scrub corpsman. 

13. All tables and stands containing sterile ar- 
ticles are draped until needed. 

14. The patient is wheeled into the operating 
room and the anesthetic is administered. 

15. By this time, the surgeon and his assistant(s) 
are dressed and scrubbed and ready to be dressed 
in sterile gowns and gloves by one of the scrub 
corpsmen. 

16. The patient's skin is prepared by the assist- 
ant or scrub corpsmen using green soap, ether 
and merthiolate or other method preferred by the 
surgeon. 

17. The patient is then draped with towels and 
sheets by the assistant and scrub corpsman. 

18. The instrument table (Mayo stand) and 
double-basin stand are rolled into place. 

19. The surgeon, assistant, and corpsman as- 
sume their proper places. 

20. The corpsman hands the scalpel to the sur- 
geon, the incision is made, after which the skin 
knife is discarded and the operation proceeds. 



SUGGESTED ADDITIONAL READING— UNIT VI 

Alexander, Edtthe. Operating Room Techniques. St. Louis : The C. V. Mosby Co., 1951. 



NURSING AND NURSING PROCEDURES 



311 



APPENDIX 
ABBREVIATIONS AND SYMBOLS 



Abbreviations Meaning 

Relating to personnel 

CO commanding officer. 

OOD officer of tbe day. 

WMO ward medical officer. 

SpW special watch. 

Relating to wards and services 

CD communicable disease. 

CDR or CSR central dressing or supply 

room. 

KENT eye. ear. nose and throat. 

GU genito-urinary. 

Lab laboratory. 

Mecano mechanotherapy. 

.Med medical. 

XP neuropsychiatric. 

OB obstetrical or maternity. 

OR operating room. 

OT occupational therapy. 

Ped pediatric or children. 

Pharm pharmacy. 

PT physical therapy. 

SOQ sick officers quarters. 

Surg surgical. 

TB tuberculosis. 

"Wd ward. 

Relating to census 

CLR census last report. 

A admitted to hospital. 

AOW admitted from other ward. 

TOW transferred to other ward. 

D discharged from hospital. 

DD discharged by death. 

Occ occupied beds. 

Vac vacant beds. 

Cap capacity beds. 

I leave or liberty. 

AOL absent over leave. 

PAL prisoner at large. 

CL critical list. 

SL serious list. 

Relating to physical examination 

BP blood pressure. 

L. L. L left lower lobe. 

L. L. Q left lower quadrant. 

L. U. L left upper lobe. 



Abbreviations Meaning 

Relating to physical examination — Continued 

L. D. Q left upper quadrant. 

os month. 

O. S left eve. 

0. d right eye. 

P. E physical examination. 

R. L. L righl lower lobe. 

R. L. Q righl lower quadrant. 

R. M. L right middle lobe. 

R. U. L right upper lobe. 

R. U. Q right upper quadrant. 

T. P. R temperature, pulse, respira- 
tion. 

Relating to tests and examinations 

BMR basal metabolism rate. 

BSP bromsulfalein test. 

CBC complete blood count. 

EEG or EECG— electroencephalogram. 

ECG or EKG electrocardiogram. 

ESR or Sed rate— erythrocyte sedimentation 
rate. 

GB series gall bladder series of X- 

rays. 

GI series gastrointestinal series of X- 

rays. 

Hgb hemoglobin. 

IVP intravenous pyelogram. 

LP lumbar puncture. 

XPX nonprotein nitrogen. 

PSP phenosulphonphthalein 

test. 

Rbc red blood cell. 

sp. gr specific gravity. 

S. & A sugar and acetone. 

VPC volume packed cells. 

wbc. & cliff white blood cell and differ- 
ential count. 
Relating to medicines 

Amp ampoul or ampule. 

horse hypodermic or subcutane- 
ous. 

1. M intramuscular. 

I. V intravenous. 

p. o by mouth. 

p. r by rectum. 



3^ 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Abbreviations Meaning 

Relating to weights and measures 

aa of each. 

ad. lib as much as desired. 

cc. cubic centimeter. 

dr dram. 

gm. gram. 

gr. grain. 

gtt drop (drops). 

Kg kilogram or 1.000 grams. 

L liter. 

lb pound. 

m. or min minum. 

mg milligram, 1000th of a gram. 

mil. or ml milliliter, 1000th of a liter. 

oz ounce. 

pt pint. 

q. s sufficient quantity. 

qt quart. 

t. or tsp teaspoon. 

T. or tbsp tablespoon. 

Relating to time 

a. c before meals. 

b. i. d twice a day. 

h. s hour of sleep or at bedtime. 

o. d every day. 

o. m every morning. 

o. n every night. 

p. c after meals. 

p. r. n when necessary. 

ql (2,3,4) h every 1 (2,3,4) hours. 

q. i. d. or 4 i. d four times a day. 

S. O. S once if necessary. 

stat at once. 

t. i. d three times a day. 

Relating to solutions 

B. A boric acid solution. 

N. S. S. or X. S normal saline solution. 

S. S. E soap suds enema. 

Relating to surgical supplies 

Abd abdominal pad. 

D. S. D dry sterile dressing. 

F sheet field sheet used to establish 

sterile field. 
4 x 4 gauze dressing folded to 

4x4 inches. 
'2 x 2 gauze dressing folded to 

2x2 inches. 



Abbreviations Meaning 

Relating to surgical operation 

0. P day of operation. 

P. O. D post operative day. 

Pre-Op before operation. 

Post-Op after operation. 

Miscellaneous 
~ with. 

C centigrade. 

DU diagnosis undetermined. 

et and. 

etc _ and so forth. 

F fahrenheit. 

Fr french, denotes size of cathe- 
ter or tube. 
sZ without. 

MEDICAL TERMINOLOGY 

Purpose: To help the corpsman gain under- 
standing of what he reads in his patients' records 
and in medical literature. 

Suggested method of study 

1. Select a new word each day. 

2. Look at it ; break it down into its parts. 

3. Write down what you think it means. 

4. Check your answer with the definition in a 
medical dictionary. 

Example 

Myocarditis 
myo card itis 
myo — muscle 
card — heart 
itis — inflammation of • 
Myocarditis: Inflammation of the muscles of 
the heart. 

PREFIXES 
Pertaining to the body 

brach arm. 

capit head. 

cardi heart. 

cholecyst gallbladder. 

cyst bladder. 

derma skin. 

entero intestines. 

glosso tongue. 

gastro stomach. 

hemo blood. 



NURSING AND NURSING PROCEDURES 



313 



Pertaining to the body — Continued 

hepat liver. 

laparo abdomen. 

myo muscle. 

nephro kidney. 

neuro nerve. 

ophtbalmo eye. 

oto ear. 

osteo bone. 

oral mouth. 

pharyn throat. 

phleb vein. 

pneumo lung. 

procto rectum. 

rhino nose. 

thoracic chest. 

Pertaining to conditions 

a- or an lacking, absence of. 

auto self. 

ante before. 

anti against. 

contra against, opposed to. 

dys difficult, painful. 

endo within. 

hemi half. 

hydro water. 

hyper above, increase, in excess. 

hypo below, under. 

mal faulty, poor. 

neo new. 

oligi scanty, few. 

poly too many, too much. 

pyo pus. 

pyro heat, temperature. 

SUFFIXES 

Pertaining to conditions of the body 

-algia pain. 

-cele tumor, hernia. 

-clysis a slow injection of a large 

amount of fluid. 

-emia blood. 

-esthesia sensation. 

-it is inflammation. 

-lith stone, calculus. 



Pertaining to conditions of the body — ( on. 

-mania Insanity. 

-oniii morbid condition, tumor. 

-opia vision. 

-pathy disease. 

-phobia fear, or dread. 

-plegia paralysis. 

-pnea breathing. 

-ptosis falling. 

-rrhea flow, discharge. 

-scopy visual examination, looking 

into. 

-therapy treatment. 

-thermy heat. 

-trophic, trophy. _. growth, nutrition. 

-uric, uria urine. 

Pertaining to surgical operations 

-ectomy removal of. 

-plasty to form, or build up. 

-pexy to fasten. 

-(o) stomy creation of an opening. 

-(o) tomy cutting into. 

-(o) rrhaphy repair of. 

-manometer used to measure pressure. 

-meter used to measure. 

-scope used to examine by looking 

into, or by hearing. 

EXAMPLES FOR PRACTICE 

1. Anemia. 17. Hypertrophy. 

2. Anesthesia. 18. Hypodermoclysis. 

3. Appendectomy. 1!). Myoma. 

4. Atrophy. 20. Nephropexy. 

5. Blepharitis. 21. Neuralgia, 
(i. Cholelithiasis. 22. Polyuria. 

7. Claustrophobia. 23. Psychopathic. 

8. Colostomy. 24. Pyromania. 
!>. Cystotomy. 25. Rectocele. 

10. Dyspnea. 26. Sphygmomanom- 

1 1. Endoscope. eter. 

12. Enteroptosis. 27. Stethoscope. 

13. Glossitis. 28. Thermometer. 

14. Gonorrhea. 2'.). Thoracoplasty. 

15. Herniorrhaphy. 30. Venechsis. 

16. Hydrotherapy. 



3*4 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



SOME SYMPTOMS 


TO BE OBSERVED AND TERMS 


TC 


» USE IN RECORDING THEM 


Concerning 


Observation 


Term to use 


Abdomen 


1. 
2. 


Hard, boardlike. 
Soft, flabby. 


1. 
2. 


Hard, rigid. 
Relaxed, flaccid, soft. 






3. 


Hurts when touched. 


3. 


Sensitive to touch. 




4. 


Appears swollen, rounded. 


4. 


Protuberant. 




5. 


Filled with gas. 


5. 


Distended, tympanites. 


Areas - - 






1. 


Epigastric. 
Right lumbar. 








2. 








3. 


Umbilical. 








4. 


Left lumbar. 








5. 


Right iliac. 








6. 


Hypogastric. 








7. 


Left iliac. 


Amounts 


1. 


Large amount : 










of drainage. 


Profuse, copious, free. 






of urine. 


Polyuria (measure in cc). 






of defecation. 


Copious. 






of emesis. 


Measured amount in cc. 




2. 


Medium amount: 










of drainage. 


Moderate, usual. 






of urine. 


Measured amount in cc. 






of defecation. 


Moderate. 






of emesis. 


Measured amount in cc. 




3. 


Small amount: 










of drainage. 


Small amount, scanty, slight, very little. 






of urine. 


Scanty (measured) in cc. 






of defecation. 


Small amount. 






of emesis. 


Measured amount in cc. 


Appetite. _ __ 


1. 


Very fussy about food, refuses to eat 
many foods. 


1. 


Has definite likes and dislikes about food. 












2. 


Eats ail foods served. 


2. 


Appetite good. 




3. 


Eats very little. 


3. 


Appetite poor. 




4. 


Loss of appetite. 


4. 


Anorexia. 




5. 


Craving for certain foods. 


5. 


List foods. 




6. 


Refuses to eat. 


6. 


Refused food (state reason). 


Arm 


1. 


Shoulder to elbow. 


1. 


Upper arm (right or left). 
Lower arm (right or left). 




2. 


Elbow to wrist. 


2. 


Back (areas) 


1. 


Upper back. 
Small of back. 


1. 


Inter-scapular shoulder region. 
Lumbar region. 




2. 


2. 




3. 


End of spine. 


3. 


Sacral region. 




4. 


Gluteal region. 


4. 


Buttocks. 


Baths__ 


1. 
2. 


Given when patient is admitted. 
All inclusive bath. 


1. 
2. 


Admission bath. 




Complete bath. 




3. 


Including: face, arms, back, axilla, and 
genitals. 


3. 


Partial bath. 




4. 


Special baths (treatments). 


4. 


Name of bath (alcohol sponge, Sitz, etc.). 


Belch- - 


Belching. 


Eructation. 


Bleeding 


1. 


Spurting of blood. 


1. 


In spurts. 




2. 


Very little. 


2. 


Oozing. 




3. 


Nosebleed. 


3. 


Epistaxis. 




4. 


Blood in vomitus. 


4. 


Hematemesis. 




5. 


Blood in urine. 


5. 


Hematuria. 




6. 


Spitting of blood. 


6. 


Hemoptysis. 




7. 


When bleeding is stopped. 


7. 


Hemorrhage controlled. 




8. 


Color. 


8. 


Bright red, dark red, frothy. 


Blister 


Blister. 

Blood pressure 120/74. 


V< 
B 


;sicle. 


Blood pressure . . . _ 


P. 120/74. 


B. M. R 


Basal metabolism rate. 

1. Unpleasant. 

2. Foul odor. 


B 

1. 

2. 


M. R. 


Breath. .___ 


Halitosis. 




Foul. 




3. 


With sweet fruitlike odor. 


3. 


Fruity. 



NURSING AND NURSING PROCEDURES 



315 



SOME SYMPTOMS TO BE OBSERVED AND TERMS TO USE IN RECORDING THEM— (on. 



Concerning 



Observation 



Term to use 



Breathing. 



Care_ 



Chill 

Coma 

Convulsion 

Cough 

Defecation. 



Dizziness .. 

Drainage. 



Dressings. 



1. Breathing. 

2. Act of inhaling. 

3. Act of exhaling. 

4. Difficull breathing. 

5. Short periods when breathing has ceased. 

6. Inability to breathe lying down. 

7. Normal breathing. 

8. Rapid breathing. 

9. Increasing dyspnea with periods of 

apnea. 

10. Snoring, breathing. 

11. Large volume of air inspired or expired. 

12. Small volume of air inspired or expired. 

13. Abnormal variation in rhythm. 

1. Oral hygiene, bedpan, face and hands 

sponged. 

2. Oral hygiene, bedpan, bath, care of hair 

and nails, alcohol back rub. 

3. Oral hygiene, bedpan, face and hands 

sponged, alcohol back rub. 

4. Special attention or treatment. 

1. Blanket applied to help warm the pa- 

tient. 

2. Type as to severity. 

3. Duration. 



Partly in coma. 
Deep in coma. 



1. Continuous shaking. 

2. Shaking with intervals of rest. 

3. Begin without warning. 

1. Coughs at all times. 

2. Coughing over a long period of time. 

3. Coughs up material. 

4. Short, hard cough. 



1. Bowel movement material. 


1. Feces, stool. 


2. Bowel movement (act of). 


2. Defecation. 


3. Excessive defecation. 


3. Diarrhea, describe. 


4. Grav colored stool. 


4. Clav colored liquid stool. 


5. Dark brown liquid stool. 


5. Highlv colored Liquid stool 


6. Formed, vet soft stool. 


6. Soft formed stool. 


7. Formed with hardened stool. 


7. Hard formed stool. 


8. Infrequent bowel movements. 


8. Constipation. 


9. Black stool. 


9. Black, tarry stool. 


Dizziness. 


Vertigo. 


1 . Watery, from nose. 


1. Corvza. 


2. Containing pus. 


2. Purulent. 


3. Bloody. 


3. Sanguinous. 


4. Consists of feces. 


4. Fecal. 


5. Of serous fluid. 


o. Serous. 


6. Containing mucus and pus. 


6. Mucopurulent. 


7. Tough, stick v. 


7. Tenacious. 


8. From vagina (after delivery). 


8. Lochia. 



1. A second dressing added to the first. 

2. Dressing removed, another applied. 

3. Drain tubes cut off. 

4. Drain taken out. 



1. Respiration. 

2. Inspiration. 

3. Expiration. 

4. Dyspnea. 

5. Apnea. 

C>. Orthopnea. 

7. Eupnea. 

8. 1 1 5 perpnea. 

9. Cheyne-Stokes respiration. 

10. Sterterous respiration. 

11. Deep breathing. 

12. Shallow breathing. 

13. Irregular respiration. 

1. Early a. m. care. 

2. Complete bath. 

3. P. M. care. 

4. Special care to back, mouth, etc. 

1. External heat applied. 

2. Severe, moderate, slight. 

3. Lasting number of minutes. 



Partially comatose. 
Profound comatose. 



1. Duration and description. 

2. Duration and description. 

3. Sudden onset. 

1. Continuous cough. 

2. Persistent cough. 

3. Productive cough, describe. 

4. Hacking cough. 



Drop I A drop or drops. 



1. Dressing reinforced. 

2. Redressed. 

3. 1 )i.iin tubes shortened (number of inches). 

4. Drain removed. 

Gtt. 



36 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



SOME SYMPTOMS TO BE OBSERVED AND TERMS TO USE IN RECORDING THEM— Con. 



Concerning 



Observation 



Term to use 



Emesis. 



Eyes 



Faint . 
Fever. 



Hives _ 
Joints. 



Gas 

Gums 

Hallucination 



Hands. 
Head- 



Legs 

Lice 

Mental attitude 



1. Produced by effort of patient. 

2. Ejected to a few feet distant. 

3. If blood is only noticeable. 

4. Material vomited. 

5. Contents. 



1. Sharpness of vision. 

2. Yellow in color. 

3. Puffy. 

4. Motionless. 

5. Sensitive to light. 

6. Double vision. 

7. Squinting. 

8. Abnormal protrusion of eyeball. 

9. Inflammation of conjunctiva. 
Fainting. 

1. Without fever. 

2. Temperature above normal. 

3. Temperature greatly above normal. 

4. Temperature suddenly returns to normal. 

5. Temperature gradually returns to normal. 

1. Gas in the digestive tract. 

2. Having gas in the digestive tract. 

3. Swelling of abdomen. 

Inflammation of the gums. 

1. Of hearing. 

2. Of sight. 

3. Of smell. 

4. Of taste. 

1. Dirty, rough, nails broken. 

2. Abnormally large. 

1. Forehead. 

2. Region over temple. 

3. Back of head. 

4. Base of skull. 

1. Hives. 

2. Itching. 

1. Bending. 

2. To straighten. 

3. Turn inward. 

4. Turn outward. 

5. Revolve around. 

6. Move away from median line. 

7. Move toward median line. 

1. Thigh to knee 

2. Knee to ankle. 

1. Head, body, pubic. 

2. Condition of lousiness. 



1. Induced. 

2. Projectile. 

3. Blood tinged. 

4. Vomitus, emesis. 

5. Describe color, odor, appearance, con- 

sistency. 



1. Visual acuity. 

2. Jaundiced. 

3. Edematous. 

4. Staring. 

5. Photophobia. 

6. Diplopia. 

7. Strabismus. 

8. Exophthalmos. 

9. Conjunctivitis. 
Syncope. 


1. 
2. 
3. 
4. 
5. 


Afebrile. 

Pyrexia. 

Hyperpyrexia. 

Crisis. 

Lysis. 


1. 

2. 
3. 


Flatus. 

Flatulence. 

Distention. 


Gingivitis. 


1. 
2. 
3. 
4. 


Auditory hallucination. 
Visual hallucination. 
Olfactory hallucination. 
Gustatory hallucination 



1. Shows lack of care. 

2. Massive. 

1. Frontal region. 

2. Temporal region. 

3. Occupital region. 

4. Basilar region. 

1. Urticaria. 

2. Pruritis. 

1. Flexion. 

2. Extension. 

3. Inversion. 

4. Eversion. 

5. Rotation. 

6. Abduction. 

7. Adduction. 

1. Upper leg (right or left). 

2. Lower leg (right or left) . 

1. Pediculi. 

2. Pediculosis. 



All statements on charts concerning attitudes must have "appears" "seems," or "appar- 
ently" before them. These are the observer's interpretations of what he thinks he sees. 
Only the patient knows for sure what his attitude is. 



1. Hard to please. 

2. Distrustful. 

3. Happv. 

4. Sad. 

5. Afraid. 

6. Over religious. 

7. Lacks emotional control. 

8. Loss of memory. 



1. Irritable, fault-finding. 

2. Distrustful, suspicious. 

3. Optimistic, cheerful. 

4. Depressed, moody. 

5. Apprehensive, anxious. 

6. Deeply religious. 

7. Hysterical. 

8. Amnesia. 



NURSING AND NURSING PROCEDURES 



317 



SOME SYMPTOMS TO BE OBSERVED AND TERMS TO USE IN RECORDING THEM— (on. 



Concerning 



Observation 



Terra to use 



Nourishment. 



Odor. 



Pain. 



Paralysis. 



Patient (admission of). 



Perspiration. 
Pulse 



Reproductive organs 

Respiration 

Restraint 

Rings 

Skin 






1. Very small amount of water. 

2. Small pieces of ice. 

3. Drink of water. 

4. Given through tube into stomach. 

5. Given by enema. 

1. Not unpleasant. 

2. Like fruit. 

3. Very unpleasant. 

4. Belonging to particular drug, etc. 

5. Like feces. 

1. Great pain. 

2. Little. 

3. Period of great pain followed by period 

of little or no pain. 

4. Spreads to distant areas. 

5. Started all at once. 

6. Hurts worse when moving. 

1. Of the muscles of the face. 

2. Of the legs. 

3. Of one side of body. 

4. Of a single limb. 

5. Both arms and legs. 

1. Walking. 

2. Carried (infant). 

3. By wheelchair. 

4. By stretcher. 

5. Had a bedsore when admitted. 



1. Large amount. 

2. Small amount. 

1. Number of beats per minute. 

2. Rhythm. 

3. Beats missed at intervals. 

4. Over 100 beats per minute. 

5. Very rapid, beats indistinct. 

6. Slow in rate. 

7. One scarcely perceptible. 

8. Small, rapid and tense. 

External reproductive organs. 
See breathing. 

1. Boards put on bed. 

2. Tied down with sheet. 

3. Fastened to bed with ankle strap (right). 

1. Rubber ring to relieve pressure. 

2. Cotton rings applied under heels, elbows, 

etc. 

1. Normal. 

2. Pink, hot. 

3. Blue in color. 

4. Very white. 

5. Shines. 

6. Raw surface. 

7. Yellow in color. 

8. Torn. 

9. Containing colored areas. 

10. Wet. 

11. Scraped. 

12. Black and blue mark. 

13. Cold, clammy. 



1. Sip- water. 

2. Chipped ice. 

3. Water (number of cc). 

4. Gav:m<\ 

"). Nutritive enema, fluid and amount. 



1. Aromatic. 

2. Fruity. 

3. Offensive. 

4. Characteristic. 

5. Fecal. 



1. Severe. 

2. Slight. 

3. Paroxysmal. 

4. Radiating. 

5. Sudden onset. 

6. Increased by movement. 

1. Facial. 

2. Paraplegia. 

3. Hemiplegia. 

4. Monoplegia. 

5. Quadriplegia. 

1. Ambulatory. 

2. In arms. 

3. Per wheelchair. 

4. Per stretcher. 

5. Decubitus ulcer present on admission; 

describe size and appearance. 

1. Profuse diaphoresis. 

2. Scanty. 

1. Rate. 

2. Regular or irregular. 

3. Intermittent. 

4. Rapid. 

"». Running, 

(i. Slow. 

7. Thready. 
s. Wiry. 

Genitalia (external). 



1. Sideboards applied. 

2. Sheet restraint applied. 

3. Right ankle strap applied. 



Placed on rubber ring. 
Cotton ring applied to each heel, elbow, 
etc. 



1. Healthv. 

2. Flushed. 

3. Cyanotic. 

J. Extreme pallor. 

5. Glossy. 

6. Excoriation. 

7. Jaundiced. 

8. Lacerated. 

9. Pigmented. 
10. Moist. 

1 l Abraded. 

12. Ecchymosis. 

13. Cold, clammy. 



MPOSMATIOH & EI ™ OFFICE 

U.S. :AL 

PORT ;IA 



3 : 3 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



SOME SYMPTOMS TO BE OBSERVED AND TERMS TO USE IN RECORDING THEM— Con. 



Concerning 


Observation 


Term to use 


Sleep... 


1. Slept very little. 

2. Tired when wakens. 


1. Slept very little or slept at short intervals. 

2. Awakens fatigued. 






3. Moans while sleeping. 


3. Sleep disturbed-moaning. 




4. Inability to sleep. 


4. Insomnia. 


Smoke 


Smokes too much. 


1. Smokes excessively. 
1. In comatose condition. 


Unconsciousness 


1. Complete unconsciousness. 




2. Partial unconsciousness. 


2. In stuporous condition. 




3. Pretended unconsciousness. 


3. Feigned unconsciousness. 


Urination 


1. To urinate. 


1. Void, micturate. 




2. No control over urination. 


2. Involuntary, incontinent. 




3. Burning when voiding. 


3. Burning sensation on micturition. 




4. Large amount of urine voided. 


4. Polyuria. 




5. Total suppression of urine. 


5. Anuria. 




6. Frequent voiding at night. 


6. Nocturia. 




7. Painful urination. 


7. Dysuria. 




8. Pus in urine. 


8. Pyuria. 




9. Blood in urine. 


9. Hematuria. 




10. Hemoglobin in urine. 


10. Hemoglobinuria. 




11. Glucose in urine. 


11. Glucosuria. 




12. Albumin in urine. 


12. Albuminuria. 




13. Acetone in urine. 


13. Acetonuria. 




14. Bile in urine. 


14. Choluria. 




15. Scantiness of urine. 


15. Oliguria. 




16. Sugar in the urine. 


16. Glycosuria. 


Vomit 


Desire to do so (for various types, see 
Emesis). 


Nausea. 






Weight.. 


1. Overweight. 

2. Thin, underweight. 


1. Obese. 




2. Emaciated. 


Wounds . __ 


1. Deep. 

2. Slight, surface only. 


1. Deep. 

2. Superficial. 






3. Not infected. 


3. Clean. 




4. Discharging pus. 


4. Suppurating. 




5. Infected. 


5. Infected. 




6. Torn. 


6. Torn. 



Chapter V 

FOOD IN HEALTH AND DISEASE 



DIET IN HEALTH 

Food is a potent weapon of warfare; it wins 
wars and keeps the peace and good will of nations. 
The happiness of a people depends on radiating 

health and vitality, which good food can bring. 
Remember, "You are what you eat." 

Functions of Foods 

Foods furnish materials needed to: 

1. Build new tissue. 

2. Maintain and repair tissue. 

3. Regulate body processes. 

4. Give energy. 

Food Composition 

Foods are composed of carbohydrates, fats, pro- 
teins, vitamins, minerals, and water. 

Carbohydrates furnish energy. Best sources: 
flour (bread, cakes, pastry), spaghetti, macaroni, 
rice, and other cereals, sugars and syrups. 

Fats furnish energy; many fats also serve as 
carriers — that is, food sources of the fat-soluble 
vitamins, vitamin A, vitamin D. vitamin E, and 
in some cases vitamin K. Best sources: butter, 
margarine fortified with vitamin A. and oils. 

Proteins furnish essential building and repair- 
ing materials for muscles and tissues of the body. 
They also furnish energy. Protein from animal 
sources in general is superior to protein from veg- 
etable sources. Best sources: milk, eggs, meat, 
fish, and poultry. Other soiu-ces: dried peas and 
beans, cereals, and vegetables. 

Vitamins are chemical substances present in 
food in minute quantities. They are necessary for 
growth and the maintenance of normal body func- 
tions. 

Vitamin A. — The functions of vitamin A in- 
clude: (1) to maintain generaHiealth; (•!) to pro- 
mote growth; (3) to maintain normal vision, espe- 
cially in dim light: (4) to promote resistance to 
infection. Best sources: butter, liver, egg yolk. 



cheese, fish liver oils, yellow and green vegetables, 
and fruits. 

Vitamin B 1 (Thiamine). — The functions "I' 
this vitamin are (1) to maintain appetite: ( -J ) to 
maintain good muscle tone: (3) to regulate nor- 
mal functioning of the nervous system; (4) to 
prevent fatigue. Best sources: liver and kidney, 
lean meat, especially pork, peas, and bean-. 

Riboflavin (Vitamin B 2 or <•). — This vitamin 
is essential to growth and well-being. In con- 
junction with other B-complex vitamins, it func- 
tions in the chemical processes of cell respiration. 
Deficiencies may result in digestive disturbances, 
nervous depression, general weakness, and poor 
conditions of the eyes and skin. Best sources: 
milk, lean meat, eggs, liver, green vegetable.-, peas, 
and beans. 

Niacin (Nicotinic Acid). — This vitamin pre- 
vents the deficiency disease called pellagra. 
Best sources: liver, lean pork, salmon, whole grain 
cereals and enriched flour, milk, and eggs. 

Vitamin C (Ascorbic Acid). — This vitamin 
(1) prevents scurvy; (2) maintains the health 
of teeth and gums; (3) aids in resistance to in- 
fections; (4) prevents listlessness and fatigue ; (•">) 
maintains strength of the bony structure and the 
walls of the blood vessels. Best sources: citrus 
fruits, raw vegetables, fresh fruits and fruit 
juices, tomatoes (raw and canned) . Other sources: 
green vegetables and potatoes, if not overcooked. 

Vitamin D. — The function of vitamin D is to 
help regulate the use of calcium and phosphorus 
in the development of the bones and teeth. Best 
sources: fish liver oils, egg yolk, liver, and irra- 
diated food. Sunshine affects the skin in such a 
way as to produce vitamin D, which is utilized in 
the same manner as vitamin D from food. 

Vitamin K. — This vitamin acts to maintain the 
normal level of prothrombin (clotting material) in 
the blood. Best sou ices : al fa I fa, spinach, cabbage, 
cauliflower, and soybean oil. 

319 



320 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Minerals 

Certain mineral elements are needed by the 
body for growth and maintenance of body struc- 
ture and processes. Some of these are so widely 
distributed in foods that they are usually supplied 
in sufficient amount in any diet. However, since 
calcium and iron may be too low unless care is 
taken in food selection, we should consider them 
at greater length. 

Calcium. — When combined with phosphorus, 
it furnishes the material from which bones and 
teeth are built, aids in the clotting of blood, and 
in regulating the action of nerves and muscles. 
Best sources : milk (whole or skim) , cheese. Other 
sources : leafy vegetables, molasses, dried beans, or 
soybeans. 

Iron. — This mineral is required for the forma- 
tion of the coloring matter of the red blood cells. 
Best sources: eggs, meat, molasses, green vege- 
tables, dried fruits, dried beans, whole grain 
cereals, and enriched flour. 

Caloric Values of Food 

An important function of food is to supply 
energy. Energy value of food is referred to as 
the caloric value. In food chemistry the unit used 
to measure the caloric value of food is the large 
calorie. The large calorie is the amount of heat 
necessary to raise the temperature of one kilogram 
of distilled water one degree centigrade. By the 
use of calorimeters, the caloric value for the differ- 
ent classes of foods have been determined to be: 
1 gram of protein yields 4 calories. 
1 gram of fat yields 9 calories. 
1 gram of carbohydrate yields 4 calories. 

The matter of providing a sufficient source of 
energy-supplying foods is seldom a problem in 
American dietaries and never a problem (except 
in isolated emergencies) in the proper nutrition 
of naval personnel. The availability of soft bev- 
erages, candy, and other sweets and the natural 
inclination of most persons to consume these take 
care of this point. It is, nevertheless, interesting 
to know something about such requirements and 
the extent to which foods vary in their ability to 
meet such requirements. 

Tables have been prepared which show the ap- 
proximate caloric values of a variety of foods; a 
few typical examples follow: 



Calories 

1 average serving of fresh beans 19 

1 teaspoon of butter 37 

1 average serving of steak or hamburger 200 

1 medium egg 71 

1 medium banana 99 

Peanuts (small package) 210 

1 small sweet roll 213 

1 piece mince pie 685 

The fuel or energy requirements of an indi- 
vidual vary widely, depending upon the nature of 
his activity. This requirement can also be meas- 
ured in terms of his oxygen consumption under 
various conditions and can be also expressed in 
calories. The energy requirements of a normal 
154-pound man under different activity conditions 
vary, in general, as follows : 

Form of activity Cal ° ries 

per hour 

Sleeping 65 

Awake lying still 77 

Standing at attention 115 

Typewriting rapidly 140 

Sweeping bare floors (38 strokes per minute j 169 

Walking slowly (2.6 miles per hour) 200 

Carpentry, metal working, industrial painting- 240 

Walking moderately fast 300 

Sawing wood 480 

Swimming 500 

Running (5.3 miles per hour) 570 

Walking upstairs 1. 100 

The probable energy requirements for one day 
of a 454-pound individual doing physical work 
may be estimated as follows : 

Calories 

8 hours of sleep (65 calories per hour) 520 

3 hours of light exercise such as going to and 

from work (170 calories per hour) 510 

8 hours of shipside painting (240 calories per 

hour) 1,920 

5 hours of sitting at rest (100 calories per 

hour) 500 

Total for the day 3, 450 

To maintain body weight without loss or gain, 
this individual would have to consume food in 
amounts and kind to yield 3,450 calories. Since 
we have assumed this man to be a normal individ- 
ual, if he consumed more, he would gain weight ; 
if he consumed less he would lose weight, unless 
some disease condition or glandular imbalance 
prevailed which interfered with his proper utiliza- 
tion of the food eaten. This balancing of food in- 
take against energy requirement is the only sane 



FOOD IN HEALTH AND DISEASE 



321 



basis of weigh! control for most of us, and this can 
only be done safely with the maintenance of a 
balanced diet which assures adequate amounts of 
all essential nutrients. 

Adequate Balanced Diet 

An adequate balanced diet should contain: 
1. Carbohydrates and fats sufficient to yield the 
energy for (a) internal activities of the body es- 
sential to life: (b) the external work to be done. 



•_'. Protein sufficient for growth and mainte- 
nance of body cells. 

3. .Minerals in adequate amounts for growth 
and maintenance of bones and teeth, and to regu- 
late body processes. 

4. Vitamins of the right kind and in the right 
amount for regulation of body processes. 

.'>. Water. 

Following is a good guide, which may be helpful 
in choosing an adequate diet : 



INCLUDE ONE OR MORE FROM EACH OF THE BASIC FOODS EACH DAY 



Basic foods 



Recommended daily 



Nutrition highlights 



Milk and milk products: Fresh fluid, 
evaporated or dehydrated milk, 
and cheese. 



Eggs: Fresh, frozen, or dehydrated. 



Hatter 



1 pint liquid or equivalent. 1 
quart for children. 



1 egg 



1 to 2 ounces. 



Meat, fowl, fish: Fresh, frozen, or 
canned. 



1 or more servings of meat, fish 
or fowl. 



Legumes: Dried kidney, lima, and Once or twice a week, 
navy beans; dried peas; also pea- 
nut butter. 



Cereals and bread: Cereals, whole 2 or more servings. 
grain or restored to whole grain 
value. 



Fruits: Fresh, frozen, canned, 2 or more servings, 1 fresh fruit 
dried, or dehydrated. when possible. Citrus fruit often. 

Vegetables: Fresh, frozen, canned, 2 or more servings besides potatoes. 
dried, or dehydrated. 1 green or yellow vegetable each 

day. Serve tomatoes and greens, 
cooked or in salads often. 



Milk furnishes protein of good quality, 
high content of vitamins, A, G (ribo- 
flavin), and considerable Hi (thiamine). 
Cheese: 5 ounces of American cheddar 
cheese is about equal to 1 quart of milk 
in calcium, phosphorus, and protein 
content. 

Eggs are especially valuable for their com- 
plete proteins, iron, phosphorus, and 
vitamin A. 

Butter is especially valuable for its vitamin 
A and fat content. 

Meat furnishes complete proteins, phos- 
phorus, iron Bi (thiamine), and (', (ribo- 
flavin). Liver is especially high in vitamin 
A. Fish are important for protein, phos- 
phorus. Salt water fish furnish iodine. 

Legumes are chiefly important as a source 
of energy, protean, phosphorus, iron, 
thiamine. Because they are not a source 
of complete proteins, legumes should be 
used only as a supplement and not a- a 
total substitution for animal proteins. 

Cereals with whole grain value, and en- 
riched bread, furnish energy, protein, 
bulk, iron, phosphorus, and vitamins 
B,, G. 

Fruits supply vitamins, minerals and bulk. 
Citrus fruits are high in vitamin C. 
yellow fruits supply generous amounts of 
vitamin A. 

Vegetables furnish valuable vitamins, min- 
erals and bulk. Green and yellow vege- 
tables are valuable for vitamin A and iron. 
Use the outer dark green leaves of lettuce 
and cabbage in salads and soups. To save 
nutrients, use water in which vegetables 
are cooked for soups, and gravies. To- 
matoes, fre>h or canned, are especially 
valuable for their vitamin C. Use them 
often, fre>h or canned. 



Note. — Other foods in form of desert-, syrups, and sugar, may be used to supplement the diet. Sugar supplies 
energy but makes no other dietary contributions. 



The maintenance of an adequate balanced diet is 
a matter that cannot he left to chance. Bear in 
mind a few simple guides : 

1. Refrain from eating candy, cake, and 
sweets — substitute fruits, nuts, and ice cream. 



•_'. Avoid as much as possible the white bleached 
flour and '•processed" cereal- — substitute whole- 
grain products. 

•".. Reduce your consumption of sugar-loaded 
soft drinks — substitute milk. 



; i 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



4. Eat all the green and yellow vegetables and 
fruit you reasonably tan, and eat at least one-third 
of these raw, except in those situations where sani- 
tary considerations might make them dangerous. 

DIET IN DISEASE 

Therapeutic Diets 

A well-balanced diet, which is necessary to 
maintain good nutrition and which has been out- 
lined in the foregoing, is the basic principle of all 
dietary prescriptions. Modifications can then be 
made to suit the various needs of the body in dis- 
ease. Many times this can be done by making one 
or two changes in the General Mess ration. 

Objectives of Dietary Treatment 

1. To increase or decrease body weight. 

2. To rest a particular organ, as when fat is 
reduced in diseases of the liver. 

3. To adjust the diet to the ability of the body 
to use certain foods, as in diabetes mellitus. 

4. To produce some specific effect as a remedy : 
for example, a high acid ash state in certain uro- 
logic diseases. 

5. To overcome deficiency states by the addition 
of foods rich in some necessary element, such as 
vitamin C in scurvy. 

6. To provide "ease of digestion" by omitting 
irritating substances, such as fiber, condiments, 
and fried foods. 

Principles of special diets prescribed for some 
specific diseased states are described below. 

Acute Fevers 

1. A liquid diet, adjusted somewhat to the pa- 
tient's appetite, will be sufficient through the acute 
state. 

2. Later the caloric and protein intake are in- 
creased, as the patient is returned to a normal diet. 

Sub-Acute Fevers (Such as Typhoid) 

1. Soft and liquid foods are given at frequent, 
regular feedings. 

2. The diet is high in calories and in protein 
(milk and eggs). 

3. The diet is high in carbohydrate and fat. 
(Cream, butter, and egg yolk are best.) 



Chronic Fevers (Such as Tuberculosis) 

1. Caloric value is slightly above normal. 

2. Relatively high protein, especially milk, is 
given. 

3. Fat is somewhat higher than normal; in 
easily digested form (cream, butter, and egg yolk). 

4. A diet high in calcium and thiamine; vita- 
mins C and D are given. 

5. Nourishment is given between meals and 
after retiring. 

Gout 

1. Since gout is a disturbance of the purine me- 
tabolism, a diet in low purine is given. 

2. During attacks all purine-containing foods 
are avoided. These are meat, fish, fowl, game, 
shellfish, asparagus, beans (kidney, lima, and 
navy), lentils, mushrooms, peas, and spinach. 

3. During remissions, on 5 clays a week, 2 ounces 
of meat, fish, or fowl (except glandular meats, 
meat extractives, broths, gravies, anchovies, roe, 
and sardines, which must be avoided entirely) or 
one-half cup of vegetables — asparagus, beans (kid- 
ney, lima, navy), lentils, mushrooms, peas, and 
spinach — may be taken. 

4. The diet may be deficient in protein, iron, and 
thiamine; thus on meat-free days, five eggs daily 
or substitute cheese (such as American or cottage 
cheese), and milk are important. 

5. Excessive use of fats should be avoided. 

Anemia 

1. A diet high in iron is given in iron deficiency 
anemias. 

2. Any foods, with emphasis on the high iron 
ones may be taken. 

3. Iron-containing foods include: (a) Milk and 
milk products, especially malt flavored ; (b) whole 
grain breads and cereals ; (c) dried fruit and nuts ; 
(d) molasses and brown sugar; (e) meat, espe- 
cially glandular meats and oysters ; (/) dried beans 
and dried peas; (g) green beet greens, chard, dan- 
delion greens, kale, spinach, and turnip greens; 
( Ji ) peanut butter. 

4. Dried brewer's yeast will increase the iron 
content. 



FOOD IN HEALTH AND DISEASE 



323 



Obesity 

1. For weigh! reduction, a diet containing ade- 
quate protein, some carbohydrate foods, and a 
minimum of fats is given. 

2. Foods allowed include: (a) Meat, eggs, cheese. 
and milk (skimmed or buttermilk on diets of 1,000 
calories or less); \l>) bread in amounts specified 
for various calorie levels (one thin slice on the 800- 
calorie diet; three thin slices on the 1,000-calorie 
diet) : (c) fruits, fresh or canned without sugar; 
(d) butter, one teaspoon on the 800-calorie diet; 
three teaspoons on the 1,000-calorie diet ; (e) clear 
broth or bouillon; and (/) vegetables, except the 
higher carbohydrate ones, such as potatoes, corn, 
lima beans. 

' 3. Foods to be avoided are: Fatty meats, salad 
dressings, nuts, cream, butter (except as allowed 
on the diet), fried foods, pastries, sugar, candy, 
jellies, jams, honey, hot breads, coffee cake, hot 
cakes, sweet rolls, waffles, cakes, cookies, puddings, 
avocados, dried fruits, dried beans and peas, po- 
tatoes, corn and lima beans, alcohol, carbonated 
beverages, catsup, chili sauce, gravy, nuts, olives, 
pickles, and relish. 

•i. Since there may be a deficiency of vitamins on 
a restricted diet, a vitamin supplement is usually 
given on the lower calorie levels. 

Underweight 

1. Patients who are underweight or who need a 
high caloric intake because of fever, increased 
metabolic rate, or poor absorption due to diarrhea 
are given a diet of 3,000 to 3,500 calories or more. 

2. High-calorie foods are emphasized; these in- 
clude cakes, cookies, ice cream, pie, puddings, but- 
ter, cream, oil. salad dressing, candy, jelly, sugar, 
gravy, and nuts. 

3. Food should be taken at regular meal times, 
in the quantity specified by the dietitian. In- 
between meal eating should be avoided, since the 
appetite may be dulled for the next meal. 

-f. Resting after meals, when possible, is de- 
sirable. 

Peptic Ulcer 

1. Frequent feedings are desirable to take up the 
free hydrochloric acid and also provide sufficient 
nourishment without overtaxing the stomach. 



2. Protein foods, such as milk and e<r<r S . are 
given to combine with the free hydrochloric acid 
present in the stomach. 

:). Cream, rich in fat, is useful because of it- 
inhibitory effect on gastric secretion and also be- 
cause of its high caloric value. 

I. All foods should be of moderate tempera- 
ture and as -oft and Smooth as possible in order 
that there will be no mechanical irritation from 
rough fibers or harsh seeds and skin.-. When 
vegetables and fruits are added to the diet, the 
ones allowed are peas, beets, carrots, pumpkin. 
spinach, string beans, squash, ripe banana, avoca- 
do, baked, canned, or stewed apples, apricots, 
cherries, peaches, pears, pureed dry fruits, and 
diluted orange juice. 

5. All foods that stimulate gastric secretion. 
such as meats and meat extractives (broths or 
gravies), acid fruits, coffee, tea. caffeine-contain- 
ing carbonated beverages, and alcohol should be 
either limited or entirely excluded. 

6. Foods which may be chemically irritating, 
such as excessively sweet, acid, salty or spicy foods, 
should be eliminated. 

7. Since the diet is limited in fresh fruits and 
vegetables, a vitamin supplement is usually pre- 
scribed. 

Gallbladder 

1. Fried foods are restricted. 

2. Foods which commonly cause gaseous dis- 
tention, such as dried beans, broccoli, brussels 
sprouts, cabbage, cauliflower, cucumbers, kohl- 
rabi, onions, dried peas, green peppers, radishes, 
rutabagas, sauerkraut, turnips, raw apples, and 
melons may be restricted in some cases. These 
foods may be tried one at a time and be included 
as tolerated. 

3. Fat may be restricted in diets of patients who 
exhibit an intolerance for it. 

Liver 

1. The diet is high in calories with emphasis on 
protein and carbohydrate rather than fat. 

2. Fat is kept low as is necessary for a palatable 
diet. Preferred fats in liver diets are egg yolk, 
milk, and cream in limited amounts. 



324 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Colostomy 

1. A low residue diet, which contains fewer 
servings of fruits and vegetables, is given. 

2. Milk is omitted to begin with, except as is 
used in cooking. Boiled milk is added and later 
wbole milk is tolerated. 

3. All foods should be soft and smooth. For 
example, refined cereals are used. Less tender 
meats are omitted. 

4. The fruits allowed include canned or cooked 
apples, apricots, cherries, peaches, pears, strained 
dried fruits, all without skin or seeds; and 
strained fruit juices. 

5. Strained vegetables and tomato juice are 
allowed. 

6. Fried foods and rich desserts are omitted. 

7. Since the diet is limited in fresh fruits and 
vegetables, a vitamin supplement is indicated. 

CLASSIFICATION OF DIETS 

The diets served in naval hospitals usually are 
liquid, soft, light, regular, and special diets. 

Liquid diets are usually ordered as "clear 
liquid" or "full liquid." A clear liquid diet in- 
cludes clear broths, rice and barley water, black 
tea or coffee, jello, and strained fruit juices. A 
full liquid diet includes all liquids served in a 
clear liquid diet with the addition of strained 
soups, strained gruels, milk and milk drinks, ice 
cream, and junket. 

Soft diet includes all liquids in addition to well- 
cooked cereals, Italian pastes, white bread and 
crackers, soft-cooked eggs, cottage cheese, soft 
cream cheese, tender fish, chicken, minced tender 
lamb and beef, sweetbreads, and brains. Baked, 
mashed, escalloped, and creamed potatoes, and 
pureed vegetables are also given on a soft diet. 
The desserts used are custards, gelatin puddings, 
simple cakes and cookies, cooked fruits without 
seeds or heavy fiber, and ripe bananas. 

Light diet includes all articles given in the soft 
diet as well as prepared cereals, whole-wheat 
bread, creamed or grated cheese, steaks, chops, 
bacon, tender roast lamb or beef, fish and liver. 
The vegetables allowed, not pureed, are asparagus, 
peas, string beans, spinach, carrots, beets, squash, 
tomatoes, and lettuce. All cooked fruits, citrus 



fruits, olives, and mayonnaise are allowed. Regu- 
lar diet is the diet served to the general mess. 

Special diets include the Sippy, Karell, and 
other special dietaries which are indicated in some 
particular diseases and which are prescribed by 
the medical officer for some particular case. 

Sample Liquid Diet 

The following is a sample of a liquid diet that 
may be easily prepared aboard ship or any small 
station. This is intended only as a guide. 

Breakfast 

Strained fruit juice. 

Strained cereal gruel. 

Milk. 

Coffee or tea with cream and sugar, if desired. 

Noon 

Strained cream soup. 

Strained fruit juice. 

Coffee or tea with sugar and cream, if desired. 

Milk. 

Ice cream, plain vanilla or chocolate. 

Supper 

Strained soup or broth. 
Strained fruit juice. 
Hot chocolate. 
Baked custard. 

Sippy Diet 

Following is an outline of the sippy diet as 
used at the U. S. Naval Hospital, Bethesda, Md. 
This diet will vary with different conditions, and 
on the advice of the medical officer. 

This diet is for 28 days and has been broken into 
numbers 1 through 5 for convenience of centralized 
meal service in hospitals : 

First through fifth day 
Sippy No. 1 

Four ounces of milk and cream, equal parts, 
every hour from 0700 to 2100. 

Two ounces orange juice, diluted, daily 0700. 

Sixth through eighth day 

Sippy No. 2 

Four ounces milk and cream, equal parts, every 
hour from 0700 to 2100. 

Strained cooked cereal, one bowl, at 0730. daily. 



FOOD IN HEALTH AND DISEASE 



325 



Two ounces orange juice, diluted, at 0730, daily. 
Strained cream soup, one bowl, at 1 180, daily. 
Baked custard (egg or plain pudding), one cus- 
tard cup at 1030, daily. 

Ninth through twelfth day 
Sippy No. 3 

Three ounces milk and cream, equal parts, every 
hour from 0700 to 2100. 

Two ounces orange juice, diluted, 0730. 
Strained cooked cereal, one bowl, 0730. 
Two soft cooked eggs, 0730. 
Toast and butter. 0730. 

1130 

Strained cream soup, one bowl. 
Bland potato. 1 
Toast and butter. 

1630 

Bland potato. 1 

Custard or plain pudding. 

Toast and butter. 

Thirteenth through twentieth day 
Sippy No. 4 

Two-thirds glass milk with one-third glass 
cream at 0900, 1300, 1500. and 2100. 

0730 

Milk, 1 glass. 

Two ounces orange juice, diluted. 

Strained cooked cereal, one bowl. 

Toast and butter. 

Bland fruit. 2 

1130 

Strained creamed soup, one bowl. 
Bland potato. 1 
Toast and butter. 
Bland fruit. 2 
Milk, 1 glass. 

1630 

Creamed soup, strained, one bowl. 

Bland potato. 1 

Custard. 

Toast and butter. 

Milk, one glass. 



1 Bland potato may be baked, boiled, mashed, creamed, or 
escalloped. 

* Bland fruit consists of canned pears, peaches, applesauce, or 
strained cooked dried fruits. 



Twenty-first through twenty-eighth day 

Sippy No. 5 
0730 

Two ounces orange juice, diluted. 
Cooked cereal or bland dry cereal. 
Two soft cooked eggs. 
Toast and butter. 
Bland fruit. 2 
Milk, one glass, 

1130 

Creamed soup. 
Tender meat. 
Bland potato. 1 
Bland puree vegetable. 
Salt (sparingly). 
Toast and butter. 
Milk, one glass. 
Bland fruit. 2 

1630 

Creamed soup. 
Bland potato. 1 
Puree vegetable. 
Custard. 

Toast and butter. 
Milk, one glass. 

Diabetic 

1. A diabetic diet is planned by the medical 
officer to meet the nutritional need- of the patient 
(sufficient caloric intake to maintain body weight 
slightly below average and adequate in essential 
nutrients). 

2. The diet is calculated to provide normal 
amount of protein, somewhat restricted amount 
of carbohydrate and sufficient tat to make up the 
caloric requirements of the patient. 

3. Cooked foods are prepared by broiling, boil- 
ing or roasting. Fried foods are to be avoided 
unless the fats used are calculated in the diet. 
Only the foods listed on his menu, in the specified 
amounts, are served to the patient. Saccharine 
may be used as a sweetening agent in the place of 
sugar. 

4. Foods allowed include: Cereals: plain un- 
sweetened breads; fresh and water packed fruits; 



211806°— 53 



-22 



326 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



fresh frozen and canned vegetables; broths and 
clear soups; lean meats, poultry and fish; milk; 
eggs ; cheeses ; butter, oils and ci*eam ; custards and 
gelatin dishes made without sugar; unsweetened 
tea, coffee, fruit juices; condiments. Potatoes 
and potato substitutes, such as macaroni, rice, 
spaghetti, noodles, corn, dried peas or beans are 
used in limited quantities. 

5. Foods to be avoided are : Sugar in all forms 
including candy, gum, honey, syrups, molasses, 
jellies, jams, and preserves; canned fruits unless 
water packed; pastries, cakes, crackers, pretzels, 
and cookies ; all sweetened desserts ; popcorn ; all 
soft drinks and alcoholic beverages. 

Cardiac 

1. In general, the diet should be low in salt or 
sodium content, should be readily digestible and 
served in frequent small feedings. The fluid in- 
take may be restricted. Any foods causing gas 
and distention should be avoided (members of 
the cabbage family, dried peas and beans). 

2. In the presence of acute cardiac failure, the 
diet may be limited to water and fruit juices for 
1 to 3 days, then increased to 800 cc. milk distrib- 
uted over the 24-hour period. As the patient 



improves, the diet is gradually increased to a full 
soft low sodium diet. 

3. Foods allowed include: unsalted meat, fish, 
poultry (one 2 to 3 ounce serving) ; milk (lim- 
ited to 500 cc. used as milk or creamed soups) ; one 
egg daily (used as egg or in cooking) ; unsalted 
cooked cereals, puffed rice or wheat, shredded 
wheat; unsalted bread and sweet* butter; fruits; 
unsalted fresh or frozen vegetables, except those 
to be avoided ; one dessert daily other than fruit ; 
unsalted cottage cheese; sugar; vegetable oils; 
jelly, marmalade ; seasonings such as lemon juice, 
paprika, garlic, extracts of vanilla, rum, lemon 
and peppermint. 

4. Foods to be avoided are : Salt and foods pre- 
pared or preserved with salt ; self -rising flours and 
mixes; cured meat, such as ham, bacon, and sau- 
sage ; fish, if processed with brine ; all cereals ex- 
cept those allowed; salted butter, mayonnaise, 
French dressing; all commercially canned vege- 
tables and beets, kale, Swiss chard, spinach, celery, 
frozen peas, lima beans ; all cheese except cottage 
cheese; salted nuts, crackers^and broths; pickles, 
olives and condiments such as catsup, chili sauce, 
prepared mustard, steak sauce, celery and onion 
salt. 



*Salted butter may be made "salt free" by kneading and wash- 
ing it under cold running water. 



REFERENCES 



Committee on Dietetics. Muyo Clinic Diet Man- 
ual. Philadelphia: W. B. Saunders Co., 1949. 

Cooper, Lenna F., Barber, Edith M., and Mitchell, 
Helen S. Nutrition in Health and Disease : 9th 
rev. ed., Philadelphia: J. B. Lippincott Co., 
1943. 

Johnson, Harry J. (ed.). B ridge 's Dietetics for 



Clinicians. 5th ed., Philadelphia: Lea and 
Febiger, 1949. 

Munsel, Hazel et al. Puttee's Dietetics. 23rd rev. 
ed., New York: G. P. Putnam's Sons. 

The Cook Book of the United Stutes Nuvy. Bu- 
reau of Supplies and Accounts, Navy Depart- 
ment. Washington : United States Government 
Printing Office, 1944. 



Chapter VI 

PREVENTIVE MEDICINE 



The old adage, "an ounce of prevention is worth 
a pound of cure,'" was never so true as in the Navy, 
where it is more important to keep a man on 
duty than to treat one who is sick and finally get 
him back to service. 

For this reason our aim is first to prevent disease 
and then to keep every man in tip-top health — a 
state of complete physical, mental, and social well- 
being. 

No matter what duties the hospital corpsman 
is assigned, he should always keep his eyes open 
to prevent the spread of disease and to improve 
the health of his shipmates. 

Communicable Diseases 

If a communicable disease breaks out aboard 
ship, it will be the duty of the hospital corpsman 
to care for the sick patient and prevent the spread 
of the disease to others. He must be aware of the 
dangers of such an outbreak. If many cases oc- 
cur, the sick bay, the medical supplies, and the 
time of the hospital corpsmen will be taxed beyond 
limit. This may also endanger the safe and ef- 
ficient operation of the vessel. 

At all times, the hospital corpsman must be 
aware of the personal dangers to himself, for 
he will of necessity be in close contact with the 
patients in the sick bay and hospital ward, and be 
exposed to infectious diseases. So he must be 
aware of how these diseases are spread, and how 
he can protect himself against them. 

Portals of Entry 

Infectious organisms enter the body through 
the skin, the respiratory tract (nose, throat, and 
lungs), the digestive tract (stomach and intes- 
tines), or the genitourinary tract (penis, bladder, 
kidneys). 

Most diseases have a specific portal of entry ; 
for example, cholera and dysentery enter through 
the digestive tract: malaria, through a skin punc- 
ture made by the anopheles mosquito: and pneu- 



monia, through tlic respiratory tract. Tetanus 
enters through deep wounds. 

If the organism happens to enter the body some 
place other than its usual portal of entry, the dis- 
ease may not develop. For example, tetanus ba- 
cilli may be harmless if swallowed along with food 
or if placed on the unbroken skin: it may cause a 
deadly infection if the bacilli enter through a deep 
wound. 

If one knows the usual portal of entry, control 
measures can be taken. For instance, food or 
water would be suspected as agents for the spread 
of dysentery or cholera since the digestive tract is 
the portal of entry for these diseases (fig. 351). 

PORTALS OF ENTRY 




RESPIRATORY 



ALIMENTARY 



GENITO- URINARY 



Figure 351. — Portals of Entry. 



327 



328 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Transmission Methods 

Disease is transmitted by the following meth- 
ods: 

By contact. — Direct contact of body surfaces of 
two or more individuals, such as that occurring 
during kissing or sexual intercourse. Venereal 
and skin diseases fall in this class. Diseases 
spread by body contact can be avoided largely 
through personal care. Cleanliness of the hands 
and clothing is obviously important. This is one 
of the reasons why good personal hygiene should 
be enforced throughout the entire ship or station. 

By direct contamination from fingers and 
hands which have been in contact with infected 
secretions, or indirect contamination of hands and 
fingers by way of doorknobs, etc. In some cases, 
sea spray over the face and hands during small- 
boat operations in polluted harbors may be the 
means of contamination. 

By spray or droplet infection from the mouth 
or nose while talking, coughing, or sneezing. 
Droplets which contain the germs inhabiting the 
mouth and respiratory passages remain in the air 
for varying lengths of time and may be scattered 
6 or 8 feet without air currents, and even farther 
if there is air movement. 

Droplet diseases can be controlled by avoiding 
sneezing or coughing close to another person. 
Covering the mouth with the hand or clean hand- 
kerchief is good standard procedure. 

A good rule is : Steer the cough onto your own 
chest and not into the chest of another. This 
should be called to the attention of personnel who 
have colds or other respiratory illnesses. 

By intermediary objects. — Foods — water and 
ice, milk and other dairy products, meat and shell 
fish, and vegetables — are often the vehicles of in- 
testinal infections such as typhoid, dysentery, or 
cholera. Parasites are commonly transmitted 
through meat. The excreta of a sick person usually 
contain great numbers of the causative organisms 
of his disease. Through carelessness these germs 
may get into the water, milk, or food and thus in- 
fect a number of new victims. 

Hospital corpsmen should ever be alert to the 



possibilities of spreading an infection from the 
sick bay to the rest of the crew. 

By f omites. — Towels, clothing, dishes — used by 
an infected person and contaminated with infected 
discharges. These, if not properly disinfected or 
sterilized, can pass on the disease to the next 
user. 

By insects as mechanical carriers of germs. — 
The common fly may carry bacteria from the dis- 
charges of an ill person in the sick bay into the 
galley and onto the food. 

At sea the fly is not generally a nuisance, but 
in port and in shore stations flies will be prevalent, 
especially in warm areas and where sanitary con- 
ditions are not satisfactory. If flies are kept away 
from infectious material, fly-borne disease will not 
be possible. Proper waste disposal, especially in 
the galleys and heads, is of importance in prevent- 
ing the presence of large numbers of flies. 

By insects acting as hosts of bacteria. — For 
example bubonic plague is generally transmitted 
from infected rats to man by the bites of fleas; 
also by fleas from other rodents. 

Since fleas are common on rats, and rats are 
frequently found aboard ships and stations, plague 
is a potential danger. This is of particular im- 
portance when a ship is tied up at or just departing 
from a plague port. 

By insects harboring microorganisms in 
their bodies which are excreted in the saliva. 
Malaria is transmitted in this way by the 
anopheles mosquito. 

Other lower animals. — For example, rabies 
from the bite of a rabid dog. 

By man acting as a carrier. — Even if a man 
is not ill he can carry or transmit diseases. 
Apparently healthy persons can carry polio and 
meningitis germs in their nose and throat. 
Chronic carriers may harbor typhoid in the gall- 
bladder, for example. Typhoid carriers should 
never be employed as food handlers. 

The first step in controlling infectious diseases 
is to know their portals of entry and how to pre- 
vent the disease germs from entering the human 
body. 



PREVENTIVE MEDICINE 



329 



THE BODY'S DEFENSES AGAINST DISEASE 

The body's defenses against disease are: 

1. The skin. 

2. The mucous membranes of the respiratory, 

digestive, and urinary tracts. 

3. Body secretions — mucus in tin respiratory 
tract catches and traps bacteria and dust: diges- 
tive juices of the stomach and Intestines tend to 
kill bacteria; perspiration tends to wash away 
bacteria. 

Body immunity. — Despite the surface defenses 
of the body to prevent these germs from entering, 
some microorganisms do find their way into the 
body. An internal resistance against infection 
is found in the blood, lymph, and other secretions 
and body tissues. The two systems which protect 
the body are the antibodies and the white blood 
cells. 

Antibodies tend to neutralize the effect of dis- 
ease germs or viruses in the body. Repeated 
small injections of a disease germ stimulates the 
formation of antibodies. For example, when we 
inject vaccines it is the production of these anti- 
bodies which later prevents the disease from de- 
veloping. In general, an antibody is specific 
against one microorganism. 

White blood cells, together with antibodies, are 
the blood warriors against micro-organisms. And 
together with antibodies, they tend to engulf 
and swallow up the disease germs, or destroy them. 

Immunity depends upon the body's resistance 
and the virulence of the invading organism. 
There are two types of immunity, inherent ( from 
birth or inherited from the mother) and acquired 
(from disease contact, inoculation, or vaccina- 
tion ) . 

Naturally acquired immunity is from disease 
contact. 

Artificially acquired immunity is from inocu- 
lation or vaccinal ion. 

Active immunity is when antibodies are pro- 
duced in or by the body of the person himself. 

In passive immunity the antibodies are first 
produced in another animal or person, such as a 
cow or horse, and then injected into the patient to 
be immunized. 



Not all diseases confer partial or complete im- 
munity by an attack. Nor is it possible to produce 
artificial immunity to all diseases. 

Methods of Prophylactic (Preventive) Immu- 
nization 

Vaccination. — Smallpox vaccination is made 
with cowpox lymph which gives a cross immunity 
in humans to smallpox. By producing a mild at- 
tack of cowpox, a person may gel Immunity which 
may last from less than 2 years to more than 20 
years. Since smallpox is an ever present threat 
vaccination is vitally important in the navy. 

Inoculation. -Killed typhoid -paratyphoid A 
and B bacilli, when injected in large numbers, 
produce an immunity to these diseases. Its dura- 
tion is variable, but become- important when en- 
tering foreign ports having poor sanitation. 
Tetanus toxoid and diphtheria toxoid contain a 
modified toxin of these organisms. The toxoid 
injection stimulates immunity, and this can be 
renewed or pushed to a higher level by later 
"booster" injections. 

Skin test for disease susceptibility is shown in 
the Schick test for diphtheria. A small drop of 
diluted toxin is injected in the outer layers of the 
skin. Only susceptible persons will get a reaction. 

Vaccination technique. — A cowpex virus must 
never be injected deeper than the skin itself. In 
performing a vaccination prepare the skin by 
wiping it with acetone or ether and let it dry. be- 
fore applying cowpox lymph. If antiseptic is 
present it will kill the virus, rendering the vacci- 
nation worthless, or cause a false reaction. So 
let the skin dry. apply a drop of the cowpox 
lymph, then hold the needle "on the Hat" or tan- 
gent to the curve of the arm jusl below the shoul- 
der. By pressing a number of times in a small 
area through the drop of cowpox lymph, yon will 
note that the skin tends to fold or roll over the 
needle point. Just let the needle barely break the 
skin without releasing blood from deeper tissues. 

Triple typhoid inoculation. — This injection 
should be made in the loose subcutaneous tissue. 
If injected beneath the sheath of the underlying 
muscle, severe reactions may follow. The ty- 
phoid "booster" consists of 0.1 cc. given intra- 
dennally. 0.5 cc. given BUDCUtaneously if intra- 
dermal reactions are intense. 



330 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Schick test. — One-tenth cc. of diluted toxin in- 
jected intradermally to the inside of the fore- 
arm. Be sure to remember the control which is 
equally important, in interpreting the reaction to 
the toxin. 

Diphtheria toxoid should be given subcutane- 
ously because of its fluid nature. 

Tetanus toxoid. — Alum-precipitated is depos- 
ited intramuscularly. 

Yellow fever vaccine instructions must be 
carefully followed. — Especially follow precau- 
tions in diluting the yellow fever vaccine so that 
uncontaminated exact amounts are injected. Note 
the lot number. 

Tuberculin test — An intradermal injection of 
0.0001 milligram of Purified Protein derivative of 
tuberculin on the volar aspect of the forearm. No 
control injection is required. 




Figure 352. — Injections of Immunizing Agents: (a) Intradermally, 
(b) Subcutaneously; (c) Intramuscularly. 

Shake before using all bacterial vaccines to 

insure good bacterial suspension. The corpsman 
giving inoculations must be sure of the correct 
dosage at all times. 

Change needles or syringe if blood is aspirated 
during an injection. In intramuscular inocula- 
tions, aspirate (draw back on the syringe plunger) 
before injection to be sure the needle has not en- 



tered a blood vessel. If repeated injections are 
made using one syringe and changing needles, 
extreme caution must be exercised. For if blood 
or plasma is aspirated the syringe as well as the 
needle must be discarded following the inocula- 
tion. A newly sterilized and filled syringe must 
then be used. In all injections made intrave- 
nously no repeated inoculations shall be made be- 
cause blood is withdrawn in each case. 

Storage of vaccines. — Vaccines, especially 
viruses such as cowpox lose their potency when 
not refrigerated. Cowpox vaccine must not re- 
main longer than one hour at temperatures above 
thawing. It should be kept in the freezing com- 
partment of the refrigerator. 

Yellow fever vaccine should be kept frozen and 
not thawed more than 60 minutes before dilut- 
ing and using. Once diluted, vaccine should be 
packed in ice. All unused portions of the diluted 
vaccine must be discarded after GO minutes. 

Cholera and typhoid vaccines and tetanus toxoid 
(alum-precipitated) should be kept under refrig- 
eration and shaken well before using. 

Typhus vaccine should also be kept refriger- 
ated. Strict attention should be paid to the in- 
structions pertaining to storage, dilution, and use 
which are printed on vaccine labels. 

For more detailed immunization facts, read sec- 
tion. "Immunization,'' Manual of the Medical De- 
partment, United States Navy, and current Bu- 
reau of Medicine and Surgery Instructions. 

Reactions 

Serum sickness. — The injection of antibodies 
sometimes causes undesirable reactions ranging 
from slightly annoying symptoms to fatal re- 
sults. Serum sickness may appear within 1 or 
2 days following an injection of a vaccine or 
inoculation but more often after 6 to 10 days. 
The patient may complain of headache, fever, 
joint and muscle pains, edema, and various skin 
eruptions such as hives. • 

Mild attacks clear up with rest, mild skin lo- 
tions, and catharsis. Epinephrine will often re- 
lieve the hives. 

Anaphylactic shock. — This occurs a few min- 
utes after the injection and may be fatal. It is 
characterized by restlessness, anxiety, difficult or 



PREVENTIVE MEDICINE 



331 



labored breathing, bluish discoloration of the skin, 
and edema. Anaphylaxis means that the patient 
is hypersusceptible to the serum or vaccine (often 
due to types grown in eggs) . 

It does not mean the antitoxin or vaccine is 
poisonous. How one becomes sensit ive is not clear. 
A previous injection of horse serum or a heredi- 
tary tendency may account for it. 

Precautions. — Because of these reactions to 
serums and e^ r g vaccines you should ask the patient 
if he has had a previous injection of serum, or if 
he is sensitive to meat, fowl, or eggs or ever had 
asthma, hives, or hay fever. 

To prevent anaphylactic shock when giving 
serum, inject one-fiftieth cc. of serum intracutane- 
ously (in the skin) as a test for hypersensitivity. 
If the test is positive, the patient should be de- 
sensitized. Unless, of course, the patient has as- 
thma aggravated by coming in contact with horses 
and is so sensitive that he cannot be desensitized. 

Patients having asthma and a strongly positive 
skin test should be given the first desensitizing dose 
subcutaneously. Begin with 0.005 cc. to 0.025 cc, 
and double the dose every half hour until a dose of 
1.28 cc. is given on the ninth dose. Then 0.1 cc. is 
injected intravenously and the dose should be dou- 
bled every twenty to thirty minutes until the re- 
quired amount is given ; dilution with physiologi- 
cal saline one to ten is advisable when unrefined 
serum is used. 

If only a mild skin reaction appears desensitiza- 
tion can be shortened by starting with a larger dose 
and increasing the size in subsequent doses. Al- 
ways keep at hand a syringe containing epineph- 
rine 1 : 1000 when administering serums or vac- 
cines. 

Treatment of Anaphylactic Shock 

Anaphylactic shock must be treated promptly. 
Stop the serum immediately. Place a tourniquet 
above the site of injection if possible. Give 
epinephrine 1 : 1000, 5/10 cc. to 1 cc. subcutaneouly. 
Repeat at short intervals if necessary, until relief 
is obtained. Make certain that the tongue of an 
unconscious patient has not blocked his airway; 
otherwise all treatment may fail to revive him. 

Whenever possible, inject serum in the outer area 
of the thigh intramuscularly, since here a tour- 
niquet may be easily applied to stop the absorption 
in case symptoms of serum sickness appear. 



SPECIAL DISEASE PROBLEMS 

For more details on communicable diseases of 
men than those given below, see The Control of 
t 'ommiinicable Diseases in M an, .American Public 
Health Association, 1950, seventh edition. This 
is official with the United States Navy and is avail- 
able in all ship and station medical libraries. 

Venereal Disease Control 

Venereal diseases require special attention be- 
cause: (1) they tend to keep hidden from medical 
observation; (2) they tend toward chronic, long- 
term physical condition; (:5) they frequently 
cause marital, family, social, and economic prob- 
lems not easily solved; and (4) prevention de- 
pends largely upon the individual. 

The Venereal Diseases 

Syphilis. — This is caused by the Spirochaeta or 
Treponema pallidum. The incubation period is 
variable (10 to 90 days, rarely longer). The first 
sore of primary or early syphilis appears at 
the site of entrance of the spirochete into the 
body. This sore, called a chancre, may last from 
1 to 6 weeks and heal with or without treatment. 
Diagnosis at this stage is by finding the spirochete 
in the dark field microscopic examinations of 
serum obtained from the chancre. Serological 
tests for syphilis will probably be negative, if the 
chancre has only recently developed. 

Secondary syphilis may appear in the form of 
macular (spotty) skin rash (often faint copper 
colored), usually accompanied by large lymph 
nodes. This rash appears :'> to 8 weeks or longer 
after the appearance of the chancre. There may 
also be papules (raised bumps), sore throat, with 
patches in the mouth, and partial loss of hair. 
These secondary signs usually disappear within 
about 3 weeks. If untreated they may reappear 
one or more times as relapses. Diagnosis may be 
made from some lesions by dark field examina- 
tions. Moist secondary sores should always Ik- 
examined by dark field. The serological test for 
syphilis is almost always positive during this 
secondary stage. 

Latent syphilis is that stage of the disease in 
which clinical signs and symptoms of infection are 
absent, the diagnosis being made by the presence 
of persistently positive serological tests and con- 



332 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



firmed by the Treponema pallidum immobiliza- 
tion test. The patient's spinal fluid is normal. 
Since there are many diseases and conditions other 
than syphilis which render standard serological 
tests positive, the diagnosis of latent syphilis 
should not be established until serological tests 
have been repeated and confirmed by a positive 
Treponema pallidum fixation test. Latent 
syphilis is arbitrarily subdivided into "early" or 
"late'' latent syphilis at a point 4 years after onset 
of infection. 

Late syphilis (formerly called tertiary syph- 
ilis) follows secondary syphilis after a period of 
quiescence for from 1 to 20 years. Among the in- 
finite variety of manifestations of this stage may 
be blindness (primary optic atrophy), insanity 
(paresis or general paralysis), vascular disease 
(disease of the heart or blood vessels) , loss of posi- 
tion sense, Charcot joints (atrophy arthritis), or 
destructive ulcers of the skin or mucous mem- 
branes. 

Gonorrhea 

This is caused by a germ, Neisseria gonorrhoeae 
or the gonococcus, a gram-negative diplococcus. 
The incubation period is from 1 to 14 days, usually 
3 to 5 days. This organism has an affinity for, 
and grows in, the urethra. 

Signs of the disease are a purulent (creamy) 
yellow discharge from the urethra in the male 
(may only be watery or mucoid) and a purulent 
yellow discharge from the cervix or urethra in the 
female. Without proper treatment, the discharge 
may be prolonged. But with penicillin treatment 
it disappears in 1 to 2 days and with sulfa drugs 
somewhat less quickly. 

Diagnosis is by microscopic examination of 
smears and by cultures. Smears are made from 
the discharge and stained with Gram stain tech- 
nique. Bacteriological cultures are necessary to 
confirm diganosis in certain instances and should 
be used as one of the criteria for cure, particularly 
in the care of females. Two negative cultures at 
24-hour intervals are recommended. The possibil- 
ity of reinfection must be considered whenever a 
positive culture follows a negative one. Follow up 
should include monthly blood tests for syphilis 
for 4 months; the test at 4 months is the most 
essential one. 

Complications of gonorrhea in untreated cases 



are inflammation of the epididymis and prostate, 
and stricture of the urthera. Pelvic inflamma- 
tory disease and inflammation of the ovaries occur 
in the female. Arthritis and sterility may occur. 
In rare instances, heart disease or septicemia oc- 
cur. The disease is infectious as long as gono- 
cocci are harbored in the prostate, cervical, or 
other genital tissues. 

Chancroid. — Chancroid is caused by the 
Ducrey bacillus (Hemophilus ducreyi) and is 
diagnosed by microscopic examinations of stained 
smears and cultures from the sore or sores, by a 
skin test (Ito-Reenstierna test). It is character- 
ized by local, rapidly developing, painful, usually 
multiple sores. The incubation period is short (3 
to 5 days) but may vary between 2 to 12 days. 
The lesions are very painful and are often accom- 
panied by a painful and tender swelling of the 
regional lymph nodes (bubos), usually unilateral. 

Lymphogranuloma venereum. — Lymphogran- 
uloma venereum is caused by a virus and 
usually starts with a small transitory sore lo- 
cated on the penis or around the genitals. It is 
a disease of the lymph nodes and channels and 
usually in bubo formation. In neglected cases it 
may cause rectal stricture (in female) and genital 
elephantiasis in both sexes. Diagnosis may be 
confirmed by the Frei test (a skin test). The in- 
cubation period varies from 1 to 4 weeks. 

Granuloma inguinale. — Granuloma inguinale 
is caused by Klebsiella granulomatis (Donovan 
body). This disease begins with a small pimple 
or painless sore after an incubation period of from 
a few days to several months. It starts as a 
papule or nodule which ulcerates and spreads by 
continuity (satellite ulcer developing near larger 
ulcers) and may involve the scrotum and thigh. 
This disease is not accompanied by bubo forma- 
tion. The disease may last for years, during which 
it may cause serious destruction of genital organs 
and spread to other parts of the body. 

Conditions simulating venereal diseases. — 
Sometimes sores or inflammations on the genitals 
are caused by ordinary organisms associated with 
unclean habits. Crab lice, scabies (the 
itch), other insect bites, Vincent's fuso-spirillosis, 
venereal warts, hair follicle infections, strep- 
tococcic and staphyloccic infections secondary to 
injuries, herpes progenitals (fever blisters), sim- 



PREVENTIVE MEDICINE 



333 



pie dermatitis, urethral discharges or sores 
repeatedly negative on laboratory examina- 
tions are to be differentiated from the venereal 
diseases. 

Under no circumstances should strong caustics, 
blue ointment, penicillin, or other antibiotic oint- 
ments be applied locally to undiagnosed genital 
infections. Penicillin, aureomycin, or the other 
newer antibiotics should never be administered 
system ically until a definite diagnosis has been es- 
tablished. (Fig. 353.) 

Venereal disease control program 

Venereal disease control in the Navy and Marine 
Corps is part of a worldwide effort to reduce the 
reservoir of venereal disease by preventing vene- 
real infection, by adequately treating all infected 
individuals, and by preventing spread of the dis- 
ease germs. Figure .">f)4 shows the coordi- 



nated venereal disease control program in the 

United States Navy and Marine Corps. 

The medical program is only one pari of the to- 
tal venereal disease control program and CO 
of: 

Education 

1. For all naval and Marine Corps person- 
nel. — Present medical facts in simple terms con- 
cerning sex hygiene and venereal disease, the 
cause, how spread, early symptoms, necessity for 
prompt reporting if infection develops or is sus- 
pected, need for follow-up, and necessity for re- 
membering names, addresses, and description of 
sexual contacts. Emphasize thai all punishment 
for getting a venereal disease has been eliminated. 

2. Medical department personnel. — Furnish- 
ing of technical information to all medical depart - 



Venereal Disease Summary Chart 



Syphilis 


Gonorrhea 


Chancroid 


Granuloma 
inguinale 


Lymphogranuloma 

venereum 


Common names or 


"Syph," "pox," "lues," "old 


"Clap." "dose." "strain," 


"Soft chancre," "bu- 


"Clcerative granuloma 


"Lymphopathia vene- 


synonvms. 


Joe," "bad blood," "hard 


"the drip." "running," 


bo," "hair cut." 


of pudenda." 


reum": "lymphogran- 




chancre," "chancre?' 


"gleet." "GC." 






uloma inguinale ." 


Germ causing dis- 


Treponema pallidum (popular 


Neisseria gonorrhea (gono- 


Ducrcy bacillus 


Donovan bodies. 


\ spedflG filterable 


ease (etiology). 


term, "spirochete"). 


coccus). 






virus. 


Method of spread . . 


il) 1 sually sexual intercourse. 


Sexual intercourse and 


Sexual intercourse 


Sexual intercourse: di- 


Sexual Intercourse; di- 




(2) Kissing and fondling. 


ophthalmia infection at 




rect contact by skin 


rect contact by skin 




(3) Prenatal (mother to fetus). 


birth. 




and mucous mem- 
brane. 


and mucous mem- 
brane. 


Incubation period 


10 to 90 days. 


1 to 14 days. 


1 to 12 days. 


2 days to several months. 


1 to 4 Weeks 


Clinical signs and 


Early: 


Male: 


Frequent multiple or 


Red, granular, shiny. 


Frequent absent 1 


symptoms. 


Primary— chancre. Second- 


Purulent urethral dis- 


single, painful, ten- 


well defined, granu- 


or presence of a pim- 




ary— rash, mucous patches, 


charge; burning on 


der, rapidly growing, 


lating ulcer, slowly 


ple or small ulceration 




sure throat, headaches, fever. 


urination; pain 


nonindurated ulcera- 


growing but progres- 


in about one-third of 




etc. 


(sometimes); inflam- 


tion, with under- 


sixe. 


the cases: Initios: rec- 




Latent (early latent; late latent) 


mation and swelling. 


mined border ragged 




tal stricture in late 




1 seropositive onlv). No active 


Female: 


edge, and gray wet 




stage in female. 




manifestations. 


Possibly no symptoms; 


base. 








Late (tertiary): 


vaginal discharges; 










Active manifestations: Cardi- 


pain in abdomen 




• 






ovascular, neurosyphilis, 


(when salpingitis oc- 










gumma, ocular, osseous, 


curs). 










\ isceral. 












Mucocutaneous relapse: 












Recurrence of infectious le- 












sions after disappearance of 












secondary lesions. 










Diagnosis 


Darklield examination. 


Smears. 


Darkfleld (to exclude 


Darklield (to exclude 


Darklield (to exclude 




Serological tests. 


Cultures. 


svphili-i. 


syphilis). 


syphilis). Case his- 




Treponema Pallidum immobili- 


Case history. 


Skin tests (Ito-Recn- 


Case history. 


tory. Clinical signs 




zation test. 


Clinical signs and symp- 


stierna). 


Clinical signs and 


and symptoms. 




Case history. 


toms. 


Presence of Ducrey ba- 


symptoms. 


I rei skin test. 




Clinical signs and symptoms. 




cillus. 


ace of Donovan 






X-ray. 




Case history. 
Clinical signs and 
symptoms. 


bodies. 




Treatment 


Penicillin. 
Arsenioals. 


Penicillin. 
Sulfonamides. 


suif>n tmides. 


Streptomycin, aure.i 
mvein. 


•i amides. 




Dilatation of rectal 




Heavy metals (bismuth). 


illation of penicillin 


11"! 


Tartar emetic, ftmdin. 


•ure. 




Combination of arsenicals and 


and sulfonamides. 




etc.. Intravenously, 






heavy metals, or all three. 






Surgery. 

X-ray 





Figure 353. — Venereal Disease Summary Chart. 



334 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



VENERAL DISEASE CONTROL IN THE US NAVY AND MARINE CORPS 




1 » t 




""cSSnTtroTS™" 



Figure 354. — Venereal Disease Control in the U. S. Navy and Marine Corps. 



ment personnel in order to properly carry out 
their personal responsibilities. 

Diagnosis, Treatment, and Follow-up 

Apply modern methods of diagnosis and 
treatment. 

Obtain adequate follow-up for evidence of cure, 
relapse, concomitant infection, or making of other 
venereal diseases. 

For additional information on this subject ob- 
tain a copy of the Guide for the Diagnosis, Treat- 
ment, Follow-up of Venereal Diseases in the 
United States Navy, NavMed P-1319. This pub- 
lication affords a convenient summary of the lat- 
est information on the administrative and clini- 
cal management of all the venereal diseases. 

Prophylaxis 

1. Early use of condom before any sex play and 
during every promiscuous sexual exposure. 

2. After exposure, immediate urination fol- 



lowed by soap and water wash of genitals and 
surounding area. 

3. Oral penicillin tablets are available as an 
additional prophylaxis measure for prevention of 
gonorrhea in noncontinental areas of high vene- 
real disease incidence. Oral penicillin tablets will 
not prevent the other venereal diseases. 

Contact Investigation 

Obtain identification and reporting of all sexual 
contacts of infected individuals for that period of 
time in which the individual could have acquired 
or spread his infection. 

Arrange for investigation of all military con- 
tacts named by infected civilians. 

For additional information on this subject ob- 
tain a copy of the Interviewer's Aid for VD Con- 
tact Investigation, NavMed P-1288. This publi- 
cation contains basic information about the 
venereal diseases, their cause, effect, epidemiology, 
methods for eliciting information by the inter- 
viewer, a copy of the contact report form and in- 



PREVENTIVE MEDICINE 



335 



structions for routing, and eleven visual aids, 
which have proved to be of inestimable value in 
patient reeducation. 

Liaison and Environmental Control 

Military forces cooperate with other gov- 
ernmental agencies, Public Health Service, law- 
enforcement officers, social welfare, and civic au- 
thorities in an effort to decrease the reservoir of 
venereal disease infections, to improve environ- 
mental conditions in cities which military person- 
nel frequent, to suppress prostitution, and to pro- 
vide wholesome recreational facilities. This re- 
quires coordination of effort between the com- 
mand, chaplain, medical, welfare, and shore patrol 
personnel. 

The Venereal Disease Educational Program 

An educational program for all naval and 
Marine Corps personnel should be conducted by 
the command, chaplain and medical departments. 
Each has a specific responsibility in the education- 
al program. The chaplain in particular should 
handle the moral and sex educational aspects of 
the control program. The Armed Forces Chap- 
lain's Visual Presentation on Sex Education (A), 
given by the chaplain, should precede the follow- 
ing medical facts presentation : 

1. Acquaint the individual with sex hygiene 
and the disease which can result from promiscuous 
sexual intercourse. 

2. Impress the facts that : 

All of the venereal diseases are caused by germs. 
A different germ causes each of these diseases, 
just as different germs are responsible for causing 
tuberculosis and the common cold. 

Venereal disease germs are usually passed from 
one person who has the VD germs in a sore on the 
sex parts or a discharge from the penis to another 
person during sexual intercourse. (For a time 
after the germ enters the other person's body, cer- 
tain symptoms, such as a sore on the sex parts or 
a discharge from the penis, may occur. This sore 
or discharge is usually the first visible evidence 
that the person has a venereal disease. Numerous 
germs are present in the sore or discharge and if 
this person has sexual intercourse with other per- 
sons during this period the germs may spread to 
them, and when they in turn develop sores or dis- 



charges germs may be passed to other.-. Thus 
each new case may start a web or series of new 
infections. 

Venereal disease germs are mainly spread by: 
Promiscuity (sexual intercourse with several 
persons, some of whom may be infected) : 
pick-ups ("loose" or "easy" women — the kind one 
may pick up in bars, dance halls, or on the street i ; 
prostitutes (women who "work" in a "house" or 
"work" on the streets). 

Venereal disease- actually exist from the mo- 
ment that the germs gel on the sex parts and begin 
to multiply. The visible symptoms of these dis- 
eases appear at varying time periods following 
sexual intercourse with an infected person. 

3. Establish firmly the early signs and symptoms 
of venereal diseases which are usually or com- 
monly noticed by the individual. I >iscuss second- 
ary symptoms and time period of occurrence of 
symptoms. Emphasize the fact that all punish- 
ment for getting a venereal disease has been elim- 
inated. Discuss dangers of self-treatment, treat- 
ment by unauthorized sources, or of failure to seek 
treatment. 

4. Establish the facts on prevention and pro- 
phylaxis. By far the best way to avoid acquiring 
a venereal disease is to avoid illicit sexual inter- 
course. If exposure is planned, then most infec- 
tions can be prevented by certain measures before 
and after exposure. The medical name of these 
measures is prophylaxis. 

Prophylaxis Consists of 

Early use of condom before any sex play and 
during every promiscuous sexual exposure. The 
condom acts as a barrier which keeps the germs 
from being passed from one person to another. 

Use of individual prophylaxis and prompt re- 
porting to prophylaxis stations (limitations of 
prophylaxis should be discussed ). 

Personal hygiene and cleanliness. 

5. Establish the responsihilty of the individual 
to: 

Avoid promiscuity. 

Use prophylaxis if exposed. 
Promptly report to a medical department when 
signs and symptoms of infection occur or are sus- 
pected. All penile sores or discharges from the 
penis should be brought to the attention of the 
medical officer. 



336 



HANDBOOK OF THE HOSPITAL CORPS, UNITED STATES NAVY 



Name all sexual contacts during that period of 
time in which the person could have acquired or 
passed on the germs which caused his infection. 

Need for adequate follow-up in case of infection. 

Suggestions for Venereal Disease Talks to 
Crew 

Use visual aids freely (films; Ozalid transpar- 
encies, NavPers 110052; magic boards; black- 
boards ; posters, etc.) . 

Have small group discussions. 

Have seminar-type discussions. (Each person 
participates in the learning process.) 

Use simple language (nontechnical) ; i. e., germs 
cause gonorrhea, rather than to say "Neisseria 
gonococci" cause gonorrhea. Do not attempt to 
get over technical facts so that the man will diag- 
nose his condition. 

Use short sentences ; explain new words. 

Attempt to leave one